33660 Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal defect), with or without atrioventricular valve repair

Name of the Procedure:

Repair of Incomplete or Partial Atrioventricular Canal (Ostium Primum Atrial Septal Defect), with or without Atrioventricular Valve Repair

Summary

This surgical procedure corrects a congenital heart defect known as an incomplete or partial atrioventricular (AV) canal. The defect involves a hole between the heart's upper chambers (atria), which affects blood flow. The surgery aims to close the hole and may also involve repairing the AV valves to ensure proper heart function.

Purpose

The procedure addresses a congenital heart defect where there is an abnormal opening between the left and right atria, known as ostium primum atrial septal defect. The goals include restoring normal blood flow, preventing complications such as heart failure or arrhythmias, and improving overall cardiac function.

Indications

• Symptoms such as shortness of breath, fatigue, or recurrent respiratory infections.
• Evidence of heart enlargement or pulmonary hypertension.
• Diagnosis of an incomplete or partial AV canal via echocardiogram or other imaging techniques.
• Patients, particularly children, showing developmental delays attributed to the heart defect.

Preparation

• Patients may need to fast for several hours before surgery.
• Adjustment or cessation of certain medications as advised by the healthcare team.
• Preoperative tests, such as blood work, chest X-rays, and echocardiograms, to assess heart function and overall health.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia to ensure they are unconscious and pain-free.
2. Incision: A median sternotomy incision is made to access the heart.
3. Heart-Lung Machine: The patient is connected to a cardiopulmonary bypass machine to maintain circulation during the surgery.
4. Repair: The surgeon locates the septal defect and patches the hole using a synthetic or pericardial patch. If necessary, the AV valves are repaired to ensure proper function.
5. Weaning Off Bypass: The patient is gradually taken off the heart-lung machine as the heart resumes its normal function.
6. Closing Incision: The sternum is wired shut, and the incision is closed with sutures.

Duration

The procedure typically takes 4-6 hours, but this can vary based on complexity and individual patient factors.

Setting

The surgery is performed in a specialized hospital setting, particularly in a cardiac surgery operating room.

Personnel

• Cardiothoracic Surgeon
• Pediatric or Adult Cardiologist
• Anesthesiologist
• Surgical Nurses and Technicians
• Perfusionist (operates the heart-lung machine)

Risks and Complications

• Common risks include bleeding, infection, and arrhythmias.
• Rare risks involve stroke, heart block needing a pacemaker, and adverse reactions to anesthesia.
• Complications are managed with medications, additional procedures, or supportive care.

Benefits

• Improved cardiac function and oxygenation.
• Relief from symptoms such as breathlessness and fatigue.
• Prevention of long-term complications like heart failure or pulmonary hypertension.
• Benefits often become noticeable within weeks to months post-surgery.

Recovery

• Initial recovery in the ICU for close monitoring.
• Total hospital stay ranges from 7-10 days.
• Follow-up includes regular cardiologist visits, echocardiograms, and potentially cardiac rehabilitation.
• Activity limitations and a gradual return to normal activities as advised by the healthcare team, generally over several months.

Alternatives

• Medical management to control symptoms, though not a definitive treatment.
• Catheter-based interventions may be available for specific cases but aren't usually suitable for this defect.
• Watchful waiting with regular monitoring for patients with minimal symptoms.

Patient Experience

• Patients will not feel anything during the surgery due to general anesthesia.
• Postoperative pain is managed with medications.
• Patients may experience discomfort at the incision site and some mild arrhythmias, which are typically temporary.
• Emotional support and patient education are essential aspects of recovery to help the patient or their family understand and manage expectations.