CPT® Code 93532

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1. Indications

The combined right heart catheterization and transseptal left heart catheterization procedure is indicated for the evaluation of congenital cardiac anomalies. This includes conditions that may affect the structure and function of the heart, necessitating detailed assessment of both the right and left heart chambers. The procedure is particularly relevant for patients presenting with symptoms or conditions such as:

• Congenital Heart Defects - Structural abnormalities of the heart present at birth that may require intervention.
• Unexplained Cyanosis - A condition characterized by a bluish discoloration of the skin due to insufficient oxygen in the blood, often linked to heart defects.
• Heart Murmurs - Abnormal sounds during the heartbeat cycle that may indicate underlying heart issues.
• Heart Failure Symptoms - Signs such as shortness of breath, fatigue, or fluid retention that may suggest heart dysfunction.

2. Procedure

The procedure involves several critical steps to ensure comprehensive evaluation of the heart's anatomy and function. Each step is designed to facilitate access to both the right and left sides of the heart for thorough assessment.

• Step 1: Right Heart Catheterization - The procedure typically begins with the insertion of a catheter through the right femoral vein. A small stab incision is made to access the vein, followed by the insertion of a needle and a sheath. A guidewire is then threaded through the femoral vein, external iliac vein, inferior vena cava, and into the right atrium. Once the catheter is positioned in the right atrium, it is advanced into the right ventricle and pulmonary arteries, allowing for inspection of the right heart chambers and measurement of pressures and oxygen levels.
• Step 2: Evaluation of Right Heart Structures - As the catheter traverses the right side of the heart, the tricuspid and pulmonary valves are inspected, and pressure gradients are obtained to assess the hemodynamics of the right heart. An angiogram of the right heart and/or pulmonary arteries may be performed if clinically indicated.
• Step 3: Transseptal Puncture - Following the right heart evaluation, the intra-atrial septum is punctured to allow the catheter to advance into the left atrium. This step is crucial for evaluating congenital anomalies that may be present in the left heart structures.
• Step 4: Evaluation of Left Heart Structures - Once in the left atrium, the catheter allows for inspection of the left atrium and mitral valve. If the catheter is further advanced into the left ventricle, the left ventricle and aortic valve are evaluated, and pressures are recorded. Pressure gradients across the aortic and mitral valves are also obtained, providing essential data for diagnosis.
• Step 5: Retrograde Left Heart Catheterization (if applicable) - If retrograde left heart catheterization is performed, a second catheter is introduced through the brachial, axillary, or femoral artery. This catheter is threaded over a guidewire placed retrograde through the artery into the aorta and into the left side of the heart, allowing for additional inspection of left heart structures and evaluation of any cardiac anomalies.

3. Post-Procedure

After the completion of the combined catheterization procedure, patients are typically monitored for any complications or adverse effects. Post-procedure care may include observation for bleeding at the catheter insertion sites, assessment of vital signs, and monitoring for any signs of arrhythmias or other cardiac issues. Patients may be advised to rest and limit physical activity for a specified period to ensure proper recovery. Follow-up appointments may be scheduled to discuss the findings from the catheterization and to plan any necessary further interventions or treatments based on the results.