93459 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ven

Name of the Procedure:

Catheter Placement in Coronary Artery(s) for Coronary Angiography with Left Heart Catheterization

Summary

This procedure involves placing a catheter in the coronary arteries to perform coronary angiography, which includes injecting contrast dye to visualize the arteries. It also involves a catheterization of the left heart to assess its function and structure, accompanied by additional injections for imaging supervision and interpretation.

Purpose

The primary goal is to diagnose and evaluate coronary artery disease, blockages, or other heart-related conditions. It helps in assessing the severity and location of artery narrowings or blockages and evaluating how well the left side of the heart is functioning.

Indications

• Symptoms of chest pain or angina.
• Abnormal stress test results.
• Unexplained shortness of breath.
• Suspected coronary artery disease.
• Evaluation of heart function post heart attack.
• Pre-surgical assessment for heart-related operations.

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjustment or temporary discontinuation of certain medications (e.g., blood thinners).
• Pre-procedure diagnostic tests like ECG, blood tests, and possibly a chest X-ray.
• Arrangements for post-procedure transportation as the patient may not be able to drive immediately after.

Procedure Description

1. The patient is positioned on an X-ray table, and an intravenous (IV) line is set up.
2. Local anesthesia is applied to the access site, usually in the groin or wrist.
3. A catheter is inserted through the access site and guided through the blood vessels to the coronary arteries using X-ray guidance.
4. A contrast dye is injected through the catheter to visualize the coronary arteries and left heart structures.
5. Imaging is performed to capture detailed views of the coronary arteries and the heart.
6. The catheter is then carefully removed, and pressure is applied to the insertion site to stop any bleeding.
7. A bandage or compression device is placed over the insertion site.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

Hospital or specialized cardiac catheterization lab.

Personnel

• Interventional cardiologist.
• Cardiac technicians or nurses.
• Anesthesiologist or nurse anesthetist, if sedation beyond local anesthesia is used.

Risks and Complications

• Allergic reaction to the contrast dye.
• Bleeding or bruising at the catheter insertion site.
• Blood vessel damage.
• Infection at the insertion site.
• Heart attack or stroke (rare).
• Irregular heart rhythms (arrhythmias).

Benefits

• Accurate diagnosis of coronary artery disease.
• Guided treatment planning for heart conditions.
• Immediate visualization of blockages for decision-making on interventions like angioplasty or stenting.
• Prompt relief from angina symptoms.

Recovery

• Monitoring in a recovery area for a few hours post-procedure.
• Instructions to avoid heavy lifting or strenuous activities for a couple of days.
• Keeping the insertion site clean and dry.
• Follow-up appointment with the cardiologist to discuss results and further treatment.

Alternatives

• Non-invasive imaging tests such as CT angiography.
• Stress testing using echocardiography or nuclear imaging.
• Medical management with lifestyle changes and medications.
• Pros: Less invasive, fewer risks.
• Cons: May be less detailed or conclusive compared to coronary angiography.

Patient Experience

• Feeling of pressure when the catheter is inserted, but generally not painful due to local anesthesia.
• Some patients may experience mild discomfort when the contrast dye is injected.
• Post-procedure soreness or bruising at the catheter insertion site.
• Pain management options include over-the-counter pain relievers if needed.