CPT® Code 92993

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1. Indications

The atrial septectomy or septostomy procedure is indicated for patients with complete transposition of the great arteries, particularly when there is a need to improve oxygen saturation levels. This condition can lead to significant hypoxemia, and the procedure aims to create a shunt between the left and right atria to facilitate better oxygenation of the blood.

• Complete Transposition of the Great Arteries This congenital heart defect results in the aorta and pulmonary artery being switched, leading to inadequate oxygenation of blood.

2. Procedure

The atrial septectomy or septostomy is performed through a series of well-defined steps. Initially, a small incision is made in the groin area to access the femoral vein. This access point is crucial as it allows for the introduction of the catheter into the vascular system. Once the femoral vein is exposed, a catheter is threaded through it and guided to the right atrium of the heart. In the case of the blade method, a blade-tipped catheter is utilized. This catheter is carefully passed through the foramen ovale, which is a natural opening between the atria, into the left atrium. Once positioned correctly, the blade is opened and then pulled back through the foramen ovale, incising the atrial septum. This action creates an opening that allows blood to flow between the left and right atria. The blade may be maneuvered multiple times between the atria to ensure that an optimal-sized opening is achieved, facilitating improved blood oxygenation.

• Step 1: A small incision is made in the groin to access the femoral vein.
• Step 2: A catheter is threaded through the femoral vein to the right atrium.
• Step 3: The blade-tipped catheter is passed through the foramen ovale into the left atrium.
• Step 4: The blade is opened and pulled back through the foramen ovale, incising the atrial septum.
• Step 5: The blade may be passed several times to create an optimal-sized opening in the atrial septum.

3. Post-Procedure

After the atrial septectomy or septostomy procedure, patients are typically monitored closely for any complications that may arise. Post-procedure care includes observation for signs of bleeding or infection at the incision site, as well as monitoring the patient's heart function and oxygen saturation levels. Recovery may vary depending on the individual patient's condition, but the goal is to ensure that the newly created atrial communication is functioning effectively to improve oxygenation. Follow-up evaluations are essential to assess the success of the procedure and to determine if any further interventions are necessary.