CPT® Code 93586

Add-On Code

1. Indications

The venography for congenital heart defect(s) is indicated in specific clinical scenarios where detailed assessment of the coronary sinus is necessary. The following conditions may warrant this procedure:

• Assessment of Congenital Heart Defects This procedure is performed to evaluate patients with congenital heart defects, particularly those who have undergone surgical interventions such as the Fontan procedure, which alters normal blood flow dynamics.
• Evaluation of Coronary Sinus Function It is indicated for assessing the function and anatomy of the coronary sinus, especially in patients presenting with symptoms related to inadequate blood flow or complications arising from previous cardiac surgeries.
• Investigation of Cardiac Symptoms The procedure may be indicated in patients experiencing unexplained cardiac symptoms, where the coronary sinus may be implicated in the underlying pathology.

2. Procedure

The procedure for venography of the coronary sinus involves several critical steps to ensure accurate imaging and assessment. The following outlines the procedural steps:

• Step 1: Catheter Placement Initially, a guide catheter is inserted through a venous access sheath, which has been previously placed in a suitable vein. This guide catheter is then threaded over a guidewire into the heart, positioning it appropriately for the subsequent steps.
• Step 2: Accessing the Coronary Sinus Once the guide catheter is in place, the guidewire is carefully directed into the coronary sinus. This step is crucial as it allows for the catheter to reach the target area where the venography will be performed.
• Step 3: Contrast Injection After successfully positioning the catheter within the coronary sinus, a contrast agent is injected. This contrast material enhances the visibility of the coronary sinus on imaging studies, allowing for a clearer delineation of blood flow within the vessel.
• Step 4: Imaging Acquisition Following the injection of contrast, radiological images are obtained. These images are essential for the radiological supervision and interpretation of the coronary sinus, providing valuable information regarding its structure and function.

3. Post-Procedure

Post-procedure care for patients undergoing venography of the coronary sinus typically involves monitoring for any immediate complications related to the catheterization process. Patients may be observed for signs of bleeding or infection at the catheter insertion site. Additionally, healthcare providers will assess the patient's vital signs and overall stability. Depending on the findings from the venography, further management or interventions may be planned. Patients are usually advised on activity restrictions and follow-up appointments to discuss the results of the imaging and any necessary next steps in their care.