CPT® Code 93527

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Combined right heart catheterization and transseptal left heart catheterization through intact septum (with or without retrograde left heart catheterization)

A combined right heart catheterization and transseptal left heart catheterization through an intact septum is a specialized medical procedure that allows for the assessment of both the right and left sides of the heart. This procedure can be performed with or without the addition of retrograde left heart catheterization. The right heart catheterization typically begins with access through the right femoral vein located in the groin area. A small incision is made to insert a needle into the vein, followed by the placement of a sheath. A guidewire is then threaded through the femoral vein, progressing through the external iliac vein, inferior vena cava, and into the right atrium. Once the catheter is positioned within the right heart chambers, various measurements such as pressure and oxygen levels are taken, and the tricuspid and pulmonary valves are evaluated. The procedure also allows for the inspection of the right heart chambers and the acquisition of pressure gradients. If necessary, a separate angiogram of the right heart and/or pulmonary arteries may be performed to visualize these structures. Following the right heart assessment, the intra-atrial septum is punctured, enabling the catheter to advance into the left atrium. Here, the left atrium and mitral valve can be inspected, and pressures can be measured. If the catheter is further advanced into the left ventricle, the left ventricle and aortic valve are also evaluated. Additionally, the right and left coronary arteries may be inspected, and separate angiograms of the aorta, left heart chambers, coronary arteries, arterial conduits, and/or aortocoronary venous bypass grafts may be obtained as needed. In cases where retrograde left heart catheterization is indicated, a second catheter is introduced through the brachial, axillary, or femoral artery. This involves puncturing the artery with a needle, placing a sheath, and threading a guidewire retrograde through the artery into the aorta and left heart structures. The left heart is then inspected, and further pressure measurements may be taken. Upon completion of the procedure, the catheter(s) are withdrawn, and a compression dressing is applied to the access site to ensure proper closure and minimize bleeding.