93591 Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve

Name of the Procedure:

Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve

Summary

This procedure involves the use of a catheter to place a closure device that stops leaks around a previously implanted aortic valve, known as a paravalvular leak. It is minimally invasive and does not require open-heart surgery.

Purpose

The procedure addresses paravalvular leaks, which occur when there is a gap between the implanted valve and heart tissue, causing blood to leak. The goal is to alleviate symptoms like heart failure or hemolysis (destruction of red blood cells), and to improve overall heart function.

Indications

• Symptoms of heart failure (e.g., shortness of breath, fatigue).
• Hemolytic anemia due to red blood cell destruction.
• Evidence of paravalvular leak on imaging studies like echocardiography.
• Patients who are at high risk for open-heart surgery.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustment or temporary discontinuation of blood-thinning medications.
• Pre-procedure diagnostic tests, including blood work, echocardiogram, and possibly a CT scan.
• Discussion with the medical team about potential allergies and current medications.

Procedure Description

1. Administration of local anesthesia and mild sedation, or general anesthesia if needed.
2. Insertion of a catheter through the femoral artery.
3. Navigation of the catheter to the site of the paravalvular leak using imaging guidance.
4. Deployment of the occlusion device through the catheter to seal the leak.
5. Verification of successful closure via real-time imaging.
6. Removal of the catheter and application of a pressure bandage to the insertion site.

Duration

The procedure typically takes 2 to 3 hours.

Setting

The procedure is performed in a hospital’s catheterization laboratory (cath lab) or a specialized cardiac center.

Personnel

• Interventional cardiologist or cardiac surgeon.
• Cardiology nurses.
• Anesthesiologist.
• Radiologic technologist.

Risks and Complications

• Bleeding at the catheter insertion site.
• Infection.
• Device migration or embolization.
• Injury to the blood vessels.
• Stroke or heart attack.
• Allergic reactions to contrast dye or medications.
• Incomplete closure of the leak.

Benefits

• Reduction or elimination of heart failure symptoms.
• Improved heart function and patient quality of life.
• Minimally invasive compared to open-heart surgery.
• Reduced risk of complications related to hemolysis.

Recovery

• Monitoring in the hospital for 24 to 48 hours.
• Gradual return to normal activities within a few days.
• Regular follow-up visits with a cardiologist to monitor heart function and device placement.
• Possible short-term use of blood-thinning medications.

Alternatives

• Open-heart surgery to repair or replace the valve, which carries higher risks, especially for high-risk patients.
• Medical management with medications, though this may not effectively address the leak.
• Continued follow-up and imaging to monitor the leak without intervention in asymptomatic patients.

Patient Experience

• Mild discomfort or pressure at the catheter insertion site.
• Possible chest discomfort during device placement.
• Pain management with medications as needed.
• Gradual improvement of symptoms within weeks to months post-procedure.