Repair of atrial septal defect and ventricular septal defect, with direct or patch closure
CPT4 code
Name of the Procedure:
Repair of Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) — also known as ASD/VSD Repair.
Summary
This procedure involves closing the abnormal openings in the heart's septum, which separates its chambers. It can be done through direct suturing or using a patch to close the hole.
Purpose
The procedure addresses congenital heart defects where there are openings between the heart's upper chambers (atria) and lower chambers (ventricles). The main goals are to restore normal blood flow, prevent heart complications, and improve overall cardiac function.
Indications
- Shortness of breath
- Fatigue
- Frequent respiratory infections
- Heart murmur detected during a physical examination
- Enlarged heart or heart failure symptoms
- Inappropriate growth in children (failure to thrive)
- Patients diagnosed with ASD/VSD through echocardiogram or other imaging studies
Preparation
- Patients are usually required to fast for 8-12 hours before surgery.
- Adjustments to current medications may be necessary, as advised by the healthcare provider.
- Blood tests, chest X-rays, and an echocardiogram are commonly performed to assess heart function and plan the surgical approach.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the chest, and the heart is accessed through the breastbone.
- The heart is temporarily stopped, and a heart-lung machine takes over blood circulation.
- The surgeon locates the defect(s) in the septum.
- The hole(s) are closed using sutures or a patch made of synthetic material or pericardium (the sac surrounding the heart).
- The heart is restarted, and normal blood flow is resumed.
- The incision is closed, and the patient is transferred to the intensive care unit (ICU) for monitoring.
Duration
The procedure typically takes 3-6 hours, depending on the complexity and number of defects being repaired.
Setting
The procedure is performed in a hospital operating room equipped with specialized surgical and cardiac equipment.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses and technicians
- Perfusionist (operates the heart-lung machine)
- ICU team for postoperative care
Risks and Complications
- Infection
- Bleeding
- Arrhythmias (irregular heartbeats)
- Stroke
- Heart block requiring a pacemaker
- Residual defects necessitating additional procedures
- Adverse reactions to anesthesia
Benefits
- Normalization of blood flow between heart chambers
- Relief from symptoms such as shortness of breath and fatigue
- Prevention of long-term complications like pulmonary hypertension and heart failure
- Improved quality of life and physical activity capacity
Recovery
- Initial recovery in the ICU for 1-2 days, followed by continued hospital stay for a total of 5-10 days.
- Gradual return to normal activities over 4-6 weeks.
- Follow-up appointments to monitor heart function and healing.
- Activity restrictions and specific care instructions will be provided by the healthcare team.
Alternatives
- Medical management to control symptoms (not typically curative for ASD/VSD).
- Catheter-based procedures for select patients with suitable defect sizes and locations.
- Pros: Non-invasive or less invasive options exist.
- Cons: May not be feasible for all patients or may require additional procedures over time.
Patient Experience
During the procedure:
- The patient will be under general anesthesia and thus will not feel or remember the surgery. After the procedure:
- Discomfort and soreness in the chest area, managed with pain medication.
- Tiredness and gradual increase in energy levels over several weeks.
- Close monitoring and supportive care in the ICU initially, with continued recovery at home.
Pain management aims to maintain comfort while ensuring a reasonable level of activity and preventing complications.