Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies
CPT4 code
Name of the Procedure:
Combined Right Heart Catheterization and Transseptal Left Heart Catheterization through Intact Septum, with or without Retrograde Left Heart Catheterization
Summary
This procedure is a specialized cardiac catheterization used to diagnose and treat congenital heart anomalies. It involves inserting catheters into the right and left sides of the heart, sometimes crossing the septum (the wall between the left and right sides of the heart) to measure pressures, take blood samples, and evaluate the heart's functionality.
Purpose
This procedure addresses congenital heart defects that affect normal heart function. It helps in diagnosing, evaluating the severity, and guiding treatment decisions for congenital cardiac anomalies.
Indications
- Cyanosis (bluish skin due to lack of oxygen)
- Shortness of breath or dyspnea
- Suspected congenital heart defects from imaging or echocardiography
- Unexplained heart murmurs
- Poor growth or development in infants and children
Preparation
- Fasting for at least 6-8 hours before the procedure
- Adjustment or temporary discontinuation of certain medications
- Blood tests, ECG, chest X-ray, and echocardiogram may be required pre-procedure
- Consent form signing and discussion with the medical team about risks and benefits
Procedure Description
- The patient is given local anesthesia and possibly mild sedation.
- A catheter is inserted through a vein in the groin or neck and guided to the right side of the heart.
- For transseptal catheterization, the catheter crosses the septum to access the left side of the heart.
- Measurements of blood pressure and oxygen levels are taken.
- Blood samples may be drawn for oxygen and metabolic analysis.
- Sometimes, an additional catheter is inserted retrograde through an artery to access the left side of the heart.
- Specialized imaging (fluoroscopy) aids in guiding catheter placement.
- After the procedure, the catheter is removed and pressure is applied to the insertion site to prevent bleeding.
Duration
The procedure typically takes 1 to 2 hours.
Setting
This procedure is performed in a hospital's cardiac catheterization lab.
Personnel
- Interventional cardiologist
- Cardiac catheterization lab nurses
- Anesthesiologist or sedation specialist
- Radiology technician
Risks and Complications
- Bleeding or hematoma at the insertion site
- Infection
- Arrhythmias or abnormal heart rhythms
- Perforation of the heart or blood vessels
- Allergic reaction to contrast dye
- Stroke or heart attack (rare)
Benefits
- Accurate diagnosis of congenital heart anomalies
- Improved understanding of heart function and pressures
- Guidance for future treatment plans, including surgical intervention if needed
- Immediate therapeutic interventions if necessary
Recovery
- Monitor in a recovery area for several hours post-procedure
- Instructions to rest and limit physical activity for 24-48 hours
- Follow-up appointment to discuss results and next steps
- Observation for any signs of complications like increased pain, swelling, or bleeding at the insertion site
Alternatives
- Non-invasive imaging tests like echocardiography, MRI, or CT scans
- Medical management depending on the severity of symptoms
- Surgical intervention without prior catheterization (less common)
Patient Experience
- Mild discomfort at the catheter insertion site
- Pressure sensation during catheter advancement
- Post-procedure soreness or bruising at the insertion site
- Minimal pain managed with over-the-counter pain relievers