Repair of complex cardiac anomalies (eg, single ventricle) by modified Fontan procedure
CPT4 code
Name of the Procedure:
Repair of complex cardiac anomalies by the modified Fontan procedure
Summary
The modified Fontan procedure is a type of heart surgery used to treat complex heart defects, such as a single ventricle. This procedure reroutes blood flow directly to the lungs, bypassing the heart, to improve oxygenation and overall heart function.
Purpose
The modified Fontan procedure addresses congenital heart defects where a single ventricle is insufficient to pump blood effectively. The goal is to divert blood flow around a non-functioning part of the heart, thereby improving oxygen levels in the blood and overall cardiac efficiency.
Indications
- Single ventricle defects
- Hypoplastic left heart syndrome
- Tricuspid atresia
- Double inlet left ventricle
- Severe congenital heart conditions requiring a total cavopulmonary connection
Patients are typically children diagnosed with these conditions who have not undergone successful correction with other surgical methods.
Preparation
- Patients are instructed to fast for several hours before the procedure.
- Medication adjustments might be needed based on the patient’s current prescriptions.
- Diagnostic tests, such as echocardiograms, chest X-rays, and blood tests, are conducted to assess heart function and overall health.
Procedure Description
- The patient is placed under general anesthesia.
- The surgeon makes an incision in the chest to access the heart.
- Cardiopulmonary bypass is used to divert blood through a heart-lung machine.
- The inferior vena cava (IVC) and superior vena cava (SVC) are connected directly to the pulmonary arteries, bypassing the heart.
- Synthetic grafts or patches might be used to create the necessary connections.
- The heart-lung machine is gradually weaned off, and the heart is re-evaluated.
- Closure of the chest incision follows, and the patient is moved to recovery.
Duration
The procedure typically lasts between 4 to 6 hours, depending on the complexity of the defect and the patient’s condition.
Setting
The procedure is performed in a hospital’s surgical suite, specifically in the cardiothoracic surgery department.
Personnel
- Cardiothoracic surgeons
- Pediatric heart surgeons (if applicable)
- Anesthesiologists
- Perfusionists (operate heart-lung machine)
- Surgical nurses
- Intensive care unit staff for post-operative care
Risks and Complications
- Bleeding
- Infection
- Arrhythmias (irregular heartbeats)
- Thrombosis (blood clots)
- Pleural effusions (fluid around the lungs)
- Liver or kidney dysfunction
- Heart failure
Management of complications typically involves medications, additional surgical interventions, or supportive therapies.
Benefits
This procedure can significantly improve the patient's quality of life by increasing blood oxygen levels and reducing symptoms of heart failure. Many patients experience a better ability to engage in physical activities and an overall improved lifespan.
Recovery
- Patients are monitored in the intensive care unit (ICU) for several days post-surgery.
- Pain management includes medications administered as needed.
- Gradual return to normal activities is encouraged, but heavy exertion should be avoided for several weeks.
- Follow-up appointments are crucial for monitoring heart function and overall recovery.
Alternatives
- Biventricular repair (if feasible)
- Palliative care options
- Heart transplant
Alternatives depend on the specifics of the heart defect. Each has its own set of benefits and drawbacks that should be discussed with a healthcare provider.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel any pain. Post-procedure, the patient may experience discomfort at the incision site and fatigue. Pain management strategies will be in place to ensure comfort. Recovery involves gradual improvement in physical capacity and activities, with close monitoring by healthcare professionals.