Repair of pulmonary venous stenosis
CPT4 code
Name of the Procedure:
Repair of Pulmonary Venous Stenosis
Summary
The repair of pulmonary venous stenosis is a surgical procedure to correct narrowing in the veins that carry blood from the lungs to the heart. This procedure helps ensure proper blood flow and oxygen transport within the body.
Purpose
This procedure addresses pulmonary venous stenosis, a condition where the pulmonary veins are narrowed, restricting blood flow from the lungs to the heart. The primary goals are to alleviate symptoms such as shortness of breath and fatigue, improve heart function, and prevent complications like pulmonary hypertension.
Indications
- Symptoms of pulmonary venous obstruction (e.g., breathlessness, fatigue, poor oxygenation)
- Evidence of pulmonary venous stenosis on imaging or diagnostic tests
- Pulmonary hypertension due to venous obstruction
- Congenital heart defects that involve pulmonary venous stenosis
Preparation
- Patients may be instructed to fast for 8-12 hours before surgery.
- Discontinuation of certain medications may be required.
- Preoperative tests may include echocardiograms, CT scans, or MRIs, as well as blood tests.
- A thorough assessment by the surgical team, including cardiologists and anesthesiologists.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: A chest incision is made to access the heart and lungs.
- Access to Pulmonary Veins: The surgeon locates the narrowed pulmonary veins.
- Widening the Veins: Techniques such as vein stenting, balloon angioplasty, or tissue patching are employed to widen the veins.
- Closing Incision: The incision is closed, and the patient is moved to recovery.
Tools used include surgical scalpels, clamps, stents, angioplasty balloons, and synthetic patches.
Duration
The procedure typically lasts between 3 to 6 hours, depending on the complexity of the stenosis.
Setting
The procedure is performed in a hospital's surgical center, often in specialized cardiac surgery units.
Personnel
- Cardiothoracic Surgeons
- Anesthesiologists
- Surgical Nurses
- Cardiologists (for pre- and post-operative care)
Risks and Complications
Common risks include bleeding, infection, and reactions to anesthesia. Rare complications might involve vein re-narrowing (restenosis), blood clots, arrhythmias, and damage to nearby structures. These can often be managed with medications or additional interventions.
Benefits
The procedure significantly improves blood flow from the lungs to the heart, alleviating symptoms and enhancing the quality of life. Many patients notice improvements within weeks to months.
Recovery
Post-operative care includes monitoring in the ICU, pain management, and gradual return to regular activity levels. The typical recovery period spans several weeks, with follow-up appointments to monitor healing and heart function.
Alternatives
- Medical Management: Using medications to manage symptoms, although not a long-term solution.
- Balloon Angioplasty alone: Less invasive but may not be as effective for severe stenosis.
- Transcatheter Procedures: Minimally invasive but not suitable for all patients.
Patient Experience
Patients can expect to be under general anesthesia during the procedure. Post-surgery, they might experience pain and discomfort at the incision site, managed with pain medication. Full recovery takes several weeks, and patients are typically advised to limit physical activity during this period. Follow-up visits will ensure proper healing and function.