33681 Closure of single ventricular septal defect, with or without patch

Name of the Procedure:

Closure of Single Ventricular Septal Defect (VSD)
Common Names: VSD Repair, Ventricular Septal Defect Closure

Summary

Closure of a single ventricular septal defect is a surgical procedure to repair a hole in the wall (septum) that separates the heart's two lower chambers (ventricles). This can be done using a patch or by suturing the hole closed directly.

Purpose

This procedure addresses the problem of a ventricular septal defect, which is a congenital heart defect. The goals are to prevent complications such as heart failure, infection, or poor growth in children, and improve overall heart function.

Indications

• Symptoms such as breathlessness, poor growth, or recurrent respiratory infections.
• Diagnosis of a VSD via echocardiogram or other imaging studies.
• Evidence of significant blood flow through the defect causing strain on the heart and lungs.

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medication adjustments may be necessary, particularly blood thinners.
• Pre-procedure tests often include blood work, a chest X-ray, and an echocardiogram.

Procedure Description

1. The patient is given general anesthesia to ensure they are unconscious and pain-free.
2. A chest incision is made to access the heart.
3. The heart is temporarily stopped, and a bypass machine takes over circulation.
4. The surgeon visually locates the VSD.
5. The defect is closed either by suturing the hole or placing a synthetic patch.
6. The heart is restarted, and normal circulation resumes.
7. The chest incision is closed with stitches or surgical staples.

Tools used include surgical instruments, a heart-lung bypass machine, and possibly synthetic patches for closing the defect.

Duration

The procedure typically takes 3 to 4 hours.

Setting

This procedure is performed in a hospital operating room with specialized cardiac surgery facilities.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (operates the heart-lung machine)
• Post-operative care team

Risks and Complications

• Common: bleeding, infection, arrhythmias
• Rare: heart block, residual VSD, need for a pacemaker, stroke Complications are managed with medications, further surgeries, or supportive care.

Benefits

• Improvement in symptoms such as breathlessness.
• Prevention of heart failure.
• Normal growth and development in children.
• Improved overall heart function, usually within weeks to months.

Recovery

• Initial recovery in the intensive care unit (ICU) for close monitoring.
• Total hospital stay ranges between 5-10 days.
• Restrictions on physical activity for several weeks.
• Follow-up appointments to monitor heart function and healing.

Alternatives

• Medication management for mild cases.
• Minimally invasive catheter-based interventions for certain types of VSDs. Each alternative has different implications regarding effectiveness, recovery time, and risks.

Patient Experience

Patients will be under general anesthesia and won't feel anything during the procedure. Post-procedure, some pain and discomfort around the incision site are normal, which can be managed with medication. Most patients experience significant improvements in their symptoms within weeks after the surgery.