Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
CPT4 code
Name of the Procedure:
Left Heart Catheterization with Intra-procedural Injection(s) for Left Ventriculography
- Common name(s): Coronary angiography, cardiac catheterization
- Technical/medical terms: Left heart catheterization, left ventriculography
Summary
Left heart catheterization with left ventriculography is a diagnostic procedure where a thin, flexible tube (catheter) is inserted into the left side of the heart to evaluate its function and check for any blockages in the coronary arteries. It includes injecting contrast dye to take detailed images of the heart’s left ventricle.
Purpose
- Medical condition: Coronary artery disease, heart failure, heart valve disorders, congenital heart defects
- Goals: To assess the function and structure of the heart's left ventricle, to diagnose blockages or other abnormalities in the coronary arteries, and guide treatment decisions.
Indications
- Symptoms: Chest pain (angina), shortness of breath, dizziness, fainting, unexplained fatigue
- Conditions: Suspected coronary artery disease, heart attack, valvular heart disease, pre-surgical evaluation for heart surgery.
- Patient criteria: Abnormal ECG, positive stress test, known coronary artery disease, high risk for cardiovascular diseases.
Preparation
- Fasting: Patients may need to fast for 6-8 hours before the procedure.
- Medications: Certain medications, particularly anticoagulants, may need to be adjusted or discontinued.
- Diagnostic tests: Blood tests, ECG, chest X-ray, and echocardiogram may be done to gather preliminary information.
Procedure Description
- The patient lies on an examination table.
- Local anesthesia is administered at the catheter insertion site, typically the wrist or groin.
- A catheter is inserted into a blood vessel and guided to the heart's left ventricle using live X-ray imaging.
- Contrast dye is injected through the catheter to visualize the heart’s structures and any blockages in the coronary arteries.
- Images are taken and analyzed by a cardiologist.
- Once imaging is complete, the catheter is removed, and the insertion site is bandaged.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is usually performed in a hospital’s cardiac catheterization lab (cath lab).
Personnel
- Cardiologist
- Cardiology nurse
- Radiologic technologist
- Anesthesiologist (if sedation beyond local anesthesia is needed)
Risks and Complications
- Common risks: Discomfort at the insertion site, bleeding, bruising, infection.
- Rare risks: Heart attack, stroke, arrhythmias, kidney damage from contrast dye, allergic reactions to the dye.
- Management: Continuous monitoring during procedure, prompt treatment of complications.
Benefits
- Provides detailed information about heart function and coronary artery health.
- Can help identify specific areas of blockage or damage.
- Information gathered can guide potentially life-saving treatments.
- Benefits can be realized shortly after the procedure if intervention (e.g., angioplasty) is performed during the same session.
Recovery
- Post-procedure care: Monitoring in a recovery area for a few hours, bed rest to ensure insertion site sealing.
- Expected recovery: Most patients can go home the same day or the next day.
- Restrictions: Avoiding strenuous activities for several days, keeping the insertion site clean and dry.
- Follow-up: Appointments to check healing and discuss results.
Alternatives
- Non-invasive imaging: Stress test, echocardiogram, CT angiography.
- Pros and cons: Less invasive but may not provide as detailed information; might not allow for immediate intervention.
Patient Experience
- During: Most patients feel pressure but not pain at the insertion site due to local anesthesia.
- After: Mild soreness at the insertion site, slight fatigue. If any discomfort, pain management can be provided.
- Comfort measures: Local anesthesia, conscious sedation if necessary, and supportive care from healthcare staff.