Name of the Procedure:

Right Heart Catheterization with Implantation of Wireless Pressure Sensor in the Pulmonary Artery (HCPCS Code: C9741)

Summary

Right heart catheterization with the implantation of a wireless pressure sensor in the pulmonary artery is a minimally invasive procedure. It involves inserting a catheter into the right side of the heart and placing a tiny wireless sensor in the pulmonary artery to monitor blood pressure continuously. The procedure may include various measurements, angiography, and imaging for accurate placement and assessment.

Purpose

The primary purpose of this procedure is to evaluate and monitor hypertension (high blood pressure) in the pulmonary artery and heart failure. It helps in the continuous monitoring of the patient's hemodynamic status, assisting clinicians in adjusting treatment plans to manage symptoms and prevent exacerbations.

Indications

• Pulmonary hypertension
• Chronic heart failure
• Unexplained shortness of breath
• Evaluation of the hemodynamic response to therapy
• Preoperative assessment for heart or lung transplant candidates

Preparation

• Fasting for at least 6-8 hours prior to the procedure.
• Discontinuation or adjustment of certain medications as per physician instructions.
• Pre-procedure diagnostic tests (e.g., blood work, echocardiogram).
• Review of medical history and physical examination.

Procedure Description

1. The patient is brought to the catheterization lab and placed on a table.
2. Sedation or local anesthesia is administered to ensure comfort.
3. A catheter is inserted through a vein in the neck (internal jugular), groin (femoral), or arm (subclavian).
4. The catheter is guided to the right side of the heart using fluoroscopy (X-ray guidance).
5. A wireless pressure sensor is deployed in the pulmonary artery.
6. Angiography and other imaging techniques ensure proper placement and functioning of the sensor.
7. The sensor transmits pressure readings wirelessly to an external device for continuous monitoring.
8. The catheter is then removed, and the insertion site is closed.

Duration

The procedure typically takes about 1-2 hours.

Setting

This procedure is performed in a hospital's catheterization laboratory or a specialized cardiovascular intervention center.

Personnel

• Interventional cardiologist or specialized cardiologist
• Nurses
• Radiology technicians
• Anesthesiologists (if moderate sedation or general anesthesia is required)

Risks and Complications

• Bleeding or infection at the catheter insertion site
• Blood vessel damage
• Cardiac arrhythmias
• Pulmonary artery injury
• Device malfunction or migration
• Allergic reactions to contrast dye or anesthesia

Benefits

• Continuous and accurate monitoring of pulmonary artery pressure
• Better management of heart failure and pulmonary hypertension
• Early detection of pressure changes, allowing timely intervention
• Improved quality of life due to optimized treatment plans

Recovery

• Patients are monitored for a few hours post-procedure in the recovery area.
• Instructions include keeping the insertion site clean and dry.
• Avoid strenuous activities for a few days.
• Follow-up appointments to monitor sensor function and data.

Alternatives

• Regular right heart catheterization without sensor implantation
• Non-invasive tests such as echocardiography or CT scans
• Medical management alone with close clinical monitoring
• Each alternative has its own pros and cons, such as less invasiveness but potentially less precise pressure data.

Patient Experience

During the procedure, the patient may feel pressure or mild discomfort at the catheter insertion site, but sedation minimizes discomfort. After the procedure, patients might experience slight soreness at the insertion site, which can be managed with over-the-counter pain relievers. Most patients can resume normal activities within a few days, following the guidelines provided by their healthcare team.