CPT® Code 93591

The procedure described by CPT® Code 93591 involves the percutaneous transcatheter closure of a paravalvular leak (PVL) specifically at the aortic valve using an initial occlusion device. A paravalvular leak occurs when there is a failure of the seal between a prosthetic heart valve and the surrounding native tissue, which can lead to serious complications such as endocarditis, hemolytic anemia, and heart failure. This procedure is performed using a vascular catheter that is inserted through the femoral artery and navigated to the heart. The approach can be either antegrade or retrograde, depending on the specific anatomy and the location of the leak. In the antegrade approach, the catheter is advanced to the left atrium, and a transseptal puncture is made to access the left ventricle. Conversely, in the retrograde approach, the catheter is passed from the left ventricle through the PVL into the left atrium. The occlusion device is then deployed to effectively cover the leak. The procedure may involve the use of multiple devices for larger defects, and the occlusion device can be repositioned as necessary to ensure optimal closure of the leak.