33476 Right ventricular resection for infundibular stenosis, with or without commissurotomy

Name of the Procedure:

Right Ventricular Resection for Infundibular Stenosis (With or Without Commissurotomy)

Summary

Right ventricular resection for infundibular stenosis is a surgical procedure that involves removing the narrowed section of the right ventricular outflow tract (the area leading out of the right ventricle) to improve blood flow from the right side of the heart to the lungs. This procedure may also include commissurotomy, where fused valve leaflets are separated.

Purpose

This procedure addresses infundibular stenosis, a condition where the outflow tract from the right ventricle is abnormally narrowed, restricting blood flow to the lungs. The goal is to alleviate this obstruction, thereby improving oxygenation and overall cardiac function.

Indications

• Severe infundibular stenosis impacting blood flow.
• Symptoms such as shortness of breath, fatigue, and cyanosis (bluish coloration due to lack of oxygen).
• Patients with associated congenital heart defects or pulmonary valve conditions.
• Significant pressure gradient observed between the right ventricle and the pulmonary artery.

Preparation

• Fasting for a specified period before surgery (usually 6-8 hours).
• Adjustment or discontinuation of certain medications as instructed.
• Preoperative imaging tests such as echocardiogram, cardiac MRI, or CT scan.
• Blood tests and possibly catheterization to assess the heart's condition.

Procedure Description

1. The patient is administered general anesthesia.
2. An incision is made in the chest to access the heart.
3. The surgeon identifies the area of infundibular stenosis.
4. The narrowed section of the right ventricular outflow tract is resected (surgically removed).
5. If needed, a commissurotomy is performed to separate fused valve leaflets.
6. The resected area may be reconstructed if necessary to ensure optimal blood flow.
7. The incision is closed, and the patient is moved to recovery.

Duration

The procedure typically takes 3 to 5 hours.

Setting

This surgery is performed in a hospital, specifically in an operating room equipped for cardiac procedures.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (operates the heart-lung machine, if used)
• Cardiologists for pre- and post-operative care

Risks and Complications

• Common risks: bleeding, infection, heart rhythm disturbances.
• Rare risks: damage to heart structures, need for re-intervention, stroke, or other cardiovascular events.
• Management: Monitoring in intensive care, medications, and potential further surgical interventions

Benefits

• Improved blood flow from the right ventricle to the lungs.
• Reduction or elimination of symptoms such as breathlessness and fatigue.
• Enhanced cardiac efficiency and overall quality of life.
• Benefits may be realized soon after recovery from surgery.

Recovery

• Initial recovery in the intensive care unit (ICU) to monitor heart function.
• Hospital stay of about 7 to 10 days.
• Instructions: limited physical activity, medication adherence, and wound care.
• Follow-up appointments for ongoing assessment.
• Full recovery and return to normal activities typically within 6 to 8 weeks.

Alternatives

• Medications to manage symptoms (though less effective for severe cases).
• Balloon dilation or stent placement (catheter-based approaches, less invasive but may be temporary).
• Heart transplantation in extreme cases with multiple heart defects.
• Pros and cons: Less invasive options might be less effective or temporary. Surgery is more definitive but comes with higher initial risks.

Patient Experience

• During procedure: Under general anesthesia, the patient will not feel pain.
• Post-procedure: Soreness, fatigue, and discomfort around the incision site.
• Pain management with prescribed medications.
• Gradual improvement in symptoms and daily functioning with adherence to recovery guidelines.