Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Left Heart Catheterization by Transseptal Puncture Through Intact Septum or by Transapical Puncture
Summary
This procedure involves the insertion of a catheter into the left side of the heart by making a puncture either through the intact septum (wall between the heart's chambers) or through the apex (bottom tip) of the heart. It is often performed to diagnose or treat certain heart conditions.
Purpose
This procedure addresses conditions where direct access to the left side of the heart is necessary. It is used to measure pressures, take tissue samples, or evaluate and treat heart diseases such as valve problems or congenital defects.
Indications
- Symptoms of heart disease like chest pain or shortness of breath
- Congenital heart defects
- Evaluation of heart valve function
- Preparation for certain surgical procedures
Preparation
- Fasting for at least 6-8 hours before the procedure
- Adjustment of medications, especially blood thinners
- Pre-procedure diagnostic tests like ECG, blood tests, and imaging studies
Procedure Description
- The patient is given local anesthesia and possibly mild sedation.
- A catheter is inserted through a vein in the groin or neck.
- For transseptal puncture, the catheter is advanced to the septum and punctured to reach the left atrium.
- For transapical puncture, access is gained directly through the apex of the heart.
- Diagnostic or therapeutic activities are performed, such as pressure measurements, tissue sampling, or treatment.
- The catheter is carefully removed, and the entry site is sealed.
Duration
Typically, the procedure takes 1 to 2 hours.
Setting
Performed in a hospital's catheterization lab or specialized surgical center.
Personnel
- Cardiologist or cardiac surgeon
- Nursing staff
- Anesthesiologist or sedation nurse
- Radiologic technologist
Risks and Complications
- Common: bleeding, infection, bruising
- Rare: heart perforation, stroke, arrhythmia, cardiac tamponade
- Management: Immediate remedial measures and supportive care in the hospital
Benefits
Provides crucial diagnostic information and/or therapeutic intervention, leading to improved heart function and quality of life. Benefits can often be observed shortly after recovery.
Recovery
- Post-procedure: Monitoring in a recovery area for a few hours
- Home care: Instructions on wound care, activity restrictions
- Recovery time: Typically a few days, with follow-up appointments as necessary
Alternatives
- Non-invasive imaging tests (limited in detailed diagnostic capability)
- Right heart catheterization (less direct access to left heart)
- Open-heart surgery (more invasive)
Patient Experience
Some discomfort at the catheter entry site and possible mild sedation effects. Pain management is available, and the patient will be closely monitored throughout and after the procedure.