Closure of multiple ventricular septal defects
CPT4 code
Name of the Procedure:
Closure of multiple ventricular septal defects (VSDs)
- Common names: VSD Closure
- Medical terms: Surgical Repair of Ventricular Septal Defects
Summary
Closure of multiple ventricular septal defects is a surgical procedure to repair holes in the wall (septum) that separates the left and right ventricles of the heart. This surgery aims to prevent abnormal blood flow between the heart chambers and improve overall cardiac function.
Purpose
This procedure addresses congenital heart defects known as ventricular septal defects, which can lead to excessive blood flow to the lungs, heart failure, and pulmonary hypertension. The goal is to close these defects, thereby normalizing blood flow and reducing the risk of associated complications.
Indications
- Symptoms such as shortness of breath, fatigue, or poor growth in infants and children
- Evidence of significant left-to-right shunt on echocardiogram
- Heart failure or pulmonary hypertension
- Recurrent respiratory infections
- Reduced oxygenation levels in the blood
Preparation
- Fasting for a specified period before the procedure (usually 8 hours)
- Adjustment or temporary discontinuation of certain medications as advised by the physician
- Pre-procedure diagnostic tests such as echocardiography, cardiac MRI, or cardiac catheterization
- Blood tests, EKG, chest X-ray, and other relevant assessments
Procedure Description
- The patient is placed under general anesthesia.
- A median sternotomy (incision through the sternum) is performed to access the heart.
- The patient is placed on a heart-lung bypass machine to maintain circulation and oxygenation during the surgery.
- The surgeon locates the VSDs in the ventricular septum.
- Each defect is closed with sutures or a synthetic patch material.
- The heart is then restarted, and the patient is weaned off the bypass machine.
- The sternum is closed with surgical wires, and the incision is sutured.
Duration
The procedure typically takes between 4 to 6 hours.
Setting
This procedure is performed in a hospital operating room equipped with cardiac surgery capabilities.
Personnel
- Cardiac Surgeon
- Anesthesiologist
- Surgical Nurses
- Perfusionist (handles the heart-lung bypass machine)
- Cardiologist
- Surgical Assistants
Risks and Complications
- Infection
- Bleeding
- Arrhythmias (irregular heartbeats)
- Incomplete closure of the defects
- Damage to nearby heart structures
- Stroke or other blood clots
- Heart block requiring a pacemaker
- Prolonged recovery or need for additional surgeries
Benefits
- Improved heart function
- Reduction or elimination of symptoms
- Decreased risk of heart failure and pulmonary hypertension
- Enhanced quality of life Benefits may be realized soon after recovery from surgery, typically within a few weeks to months.
Recovery
- Initial recovery in the Intensive Care Unit (ICU) for close monitoring
- Hospital stay of around 5 to 10 days post-surgery
- Pain management with prescribed medications
- Gradual resumption of activities with specific restrictions
- Follow-up appointments with the cardiologist and surgeon
- Regular echocardiograms to monitor heart function
Alternatives
- Medical management with medications to control symptoms (not a definitive solution)
- Interventional catheter procedures for specific types of VSDs (less invasive, but not suitable for multiple or large defects)
- Heart transplant in severe cases where multiple defects are part of a complex condition
Patient Experience
- The patient will be under general anesthesia during the procedure and will not experience pain.
- Postoperative discomfort includes pain at the incision site, managed with painkillers.
- Gradual improvement in symptoms and energy levels after recovery.
- Psychological support may be beneficial to cope with the emotional aspects of undergoing major heart surgery.