Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed
CPT4 code
Name of the Procedure:
Right Heart Catheterization (RHC)
Also known as Pulmonary Artery Catheterization, Right Cardiac Catheterization
Summary
Right heart catheterization is a minimally invasive procedure that involves threading a thin, flexible tube (catheter) through the veins to the right side of the heart and into the pulmonary artery. This allows doctors to measure various heart pressures, oxygen levels, and evaluate cardiac output.
Purpose
Right heart catheterization helps diagnose and manage conditions affecting the heart and lungs, such as heart failure, pulmonary hypertension, and congenital heart defects. The primary goals are to obtain accurate measurements of heart pressures and assess the heart's pumping capability.
Indications
- Symptoms of heart failure (e.g., shortness of breath, fatigue)
- Suspected pulmonary hypertension
- Evaluation of congenital heart defects
- Monitoring treatment efficacy for certain heart and lung conditions
- Preoperative assessment for heart or lung transplantation
Preparation
- Fasting for 6-8 hours before the procedure
- Adjustment or temporary discontinuation of certain medications as directed by a doctor
- Pre-procedure diagnostic tests like blood work, ECG, echocardiogram
Procedure Description
- The patient is positioned on an examination table, typically in a cardiac catheterization lab.
- A sedative and local anesthetic are administered to ensure comfort.
- A catheter is inserted through a vein in the neck, groin, or arm.
- The catheter is carefully guided to the right side of the heart and pulmonary artery using X-ray imaging (fluoroscopy).
- Measurements of heart pressures, oxygen levels, and cardiac output are taken.
- The catheter is removed, and the insertion site is bandaged.
Duration
The procedure typically takes 30 minutes to 1 hour.
Setting
Right heart catheterization is performed in a hospital, specifically in a cardiac catheterization lab.
Personnel
- Cardiologist or interventional cardiologist
- Nurses
- Radiologic technologists
- Anesthesiologist (if deeper sedation is used)
Risks and Complications
- Bleeding or bruising at the catheter insertion site
- Infection
- Arrhythmias (irregular heartbeats)
- Blood clots
- Rarely, damage to the heart or blood vessels
Benefits
- Accurate diagnosis of heart and lung conditions
- Improved management and treatment plans
- Immediate data on heart function and pressures
Recovery
- Observation period in a recovery area (usually a few hours)
- Instructions to keep the insertion site clean and dry
- Avoid strenuous activity for a few days
- Follow-up appointment to discuss results and ongoing care
Alternatives
- Echocardiogram: Non-invasive, but may not provide detailed pressure measurements
- MRI or CT scan: Useful for anatomical details but not real-time pressure data
- Non-invasive cardiac output monitoring: Less precise than catheterization
Patient Experience
During the procedure, patients might feel some pressure or mild discomfort at the catheter insertion site. Post-procedure, patients could experience soreness or bruising at the insertion site. Pain management includes over-the-counter pain relievers as recommended. Comfort measures, such as bed rest and activity restrictions, will be advised during recovery.