Repair of complex cardiac anomaly other than pulmonary atresia with ventricular septal defect by construction or replacement of conduit from right or left ventricle to pulmonary artery
CPT4 code
Name of the Procedure:
Repair of complex cardiac anomaly (other than pulmonary atresia with ventricular septal defect) by construction or replacement of conduit from right or left ventricle to pulmonary artery
Summary
This intricate heart surgery aims to correct complex congenital heart defects by creating or replacing a conduit (tube) that allows proper blood flow between the right or left ventricle and the pulmonary artery.
Purpose
The procedure addresses severe congenital heart defects that cause abnormal blood flow. By establishing a functional conduit, it aims to improve heart efficiency, enhance oxygen delivery to the body, and reduce symptoms such as breathlessness and fatigue.
Indications
- Severe congenital heart defects involving improper connections between ventricles and pulmonary artery.
- Symptoms such as cyanosis (bluish skin), fatigue, and shortness of breath.
- Previous heart surgeries that need correction or update.
- Diagnostic imaging that shows a need for a new or revised conduit.
Preparation
- Fasting from midnight before the surgery.
- Adjustment or cessation of certain medications as directed by the doctor.
- Pre-surgical tests like echocardiogram, chest X-ray, and blood tests.
- Detailed discussion with healthcare providers regarding the procedure, risks, and benefits.
Procedure Description
- Administer general anesthesia to the patient.
- Make an incision in the chest to access the heart.
- Use a heart-lung bypass machine to maintain circulation and oxygenation.
- Identify and isolate the area of the defect.
- Construct or replace the conduit – a flexible tube or graft – between the right or left ventricle and the pulmonary artery, ensuring secure attachments.
- Once the conduit is in place and functioning properly, remove the patient from the heart-lung machine and close the incision.
Tools used include surgical instruments, heart-lung bypass machine, and synthetic or biological conduit materials.
Duration
The procedure typically takes between 4 to 8 hours, depending on the complexity of the case.
Setting
This procedure is performed in a specialized cardiac surgery operating room within a hospital.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (operates the heart-lung machine)
- Surgical technician
Risks and Complications
- Infection
- Bleeding
- Blood clots
- Arrhythmias (irregular heartbeats)
- Reaction to anesthesia
- Need for additional surgeries
- Complications specific to heart function and conduit placement
Benefits
- Improved heart function and overall blood flow
- Reduced symptoms like breathlessness and cyanosis
- Enhanced quality of life
- Potential lifespan increase
Recovery
- Initial recovery in the Intensive Care Unit (ICU) for close monitoring.
- Hospital stay ranging from 7 to 14 days depending on the patient's condition.
- Pain management with medications.
- Gradual resumption of activities over 4 to 6 weeks.
- Regular follow-up appointments with the cardiologist.
- Restrictions on strenuous activities until fully healed.
Alternatives
- Medication management, though often insufficient for complex anomalies.
- Heart transplant in severe cases.
- Catheter-based interventions, which may be less invasive but not always feasible for complex defects.
Patient Experience
During the procedure, the patient will be under general anesthesia and feel nothing. Post-surgery, they may experience soreness, fatigue, and discomfort, which can be managed with pain medications. Psychological support and physical rehabilitation may aid in the recovery and adjustment process.