92998 Percutaneous transluminal pulmonary artery balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure)

Name of the Procedure:

Percutaneous Transluminal Pulmonary Artery Balloon Angioplasty (PTPABA); Each Additional Vessel

Summary

Percutaneous Transluminal Pulmonary Artery Balloon Angioplasty (PTPABA) is a minimally invasive procedure that involves the use of a balloon catheter to widen narrowed arteries in the lungs. This description pertains to additional vessels treated, in conjunction to a primary procedure.

Purpose

Condition Addressed: Narrowing (stenosis) of the pulmonary arteries. Goals/Outcomes: To improve blood flow to the lungs, reduce symptoms such as shortness of breath, and enhance overall heart function.

Indications

Symptoms/Conditions: Shortness of breath, reduced exercise capacity, fatigue, or evidence of pulmonary hypertension. Patient Criteria: Suitable for patients with pulmonary artery stenosis that has not responded to medical treatment or other interventions.

Preparation

• Pre-Procedure Instructions: Patients are typically advised to fast for 6-8 hours before the procedure.
• Medication Adjustments: Anticoagulants and other medications may need to be halted or adjusted.
• Diagnostic Tests: Pre-procedure imaging, such as an echocardiogram or CT scan, and blood tests are usually required.

Procedure Description

1. Catheter Insertion: A catheter is inserted through a vein in the groin or arm and guided to the pulmonary artery.
2. Balloon Inflation: A small balloon attached to the catheter is inflated to widen the narrowed artery.
3. Stent Placement: In some cases, a stent (a small mesh tube) may be placed to keep the artery open.
4. Completion: The balloon is deflated and the catheter is removed.

Tools/Technology: Balloon catheter, guide wire, possibly a stent. Anesthesia: Local anesthesia at the insertion site; sedation may be provided for patient comfort.

Duration

Typically takes 1-2 hours per vessel treated.

Setting

Usually performed in a hospital's catheterization laboratory (cath lab).

Personnel

• Interventional cardiologist or radiologist
• Nurses and technicians
• Anesthesiologist or sedation nurse

Risks and Complications

• Common Risks: Bleeding at the catheter insertion site, allergic reactions to contrast dye.
• Rare Complications: Artery rupture, blood clot formation, kidney injury due to contrast dye, infection.

Benefits

• Expected Benefits: Improved blood flow in the lungs, relief from symptoms, increased exercise tolerance.
• Realization: Benefits are often immediate, with continued improvement over weeks to months.

Recovery

• Immediate Care: Monitoring in a recovery room for a few hours post-procedure.
• Recovery Time: Typically brief, with most patients returning to normal activities within a few days.
• Follow-Up: Regular follow-up appointments to monitor artery health and heart function.

Alternatives

• Medical Therapy: Medications to manage symptoms.
• Surgical Options: Pulmonary endarterectomy for certain cases.
• Pros and Cons: Balloon angioplasty is less invasive with a shorter recovery time compared to surgery, but may require re-intervention.

Patient Experience

• During the Procedure: Mild discomfort at insertion site, possible sensation of pressure or mild pain as the balloon is inflated.
• After the Procedure: Mild soreness at insertion site, fatigue for 1-2 days. Pain is typically managed with over-the-counter pain relievers.
• Comfort Measures: Sedation and local anesthesia to minimize discomfort.