Replacement, pulmonary valve
CPT4 code
Name of the Procedure:
Pulmonary Valve Replacement (PVR), Pulmonary Valve Surgery
Summary
Pulmonary valve replacement involves removing a damaged or diseased pulmonary valve and replacing it with a new one. The replacement can be done using a bioprosthetic (tissue) valve or a mechanical valve.
Purpose
Pulmonary valve replacement addresses conditions where the pulmonary valve is not working properly, such as pulmonary valve stenosis (narrowing) or regurgitation (leakage). The goals are to ensure proper blood flow from the right ventricle to the lungs, relieve symptoms, and improve heart function and overall quality of life.
Indications
- Severe pulmonary valve stenosis or regurgitation
- Congenital heart defects affecting the pulmonary valve
- Right ventricular dilation or dysfunction due to valve problems
- Symptoms like shortness of breath, chest pain, fatigue, or fainting spells
- Failed previous valve repair or replacement
Preparation
- Fasting for at least 8 hours before the procedure
- Adjusting medications as instructed by the doctor, including stopping blood thinners if necessary
- Undergoing diagnostic tests such as echocardiograms, cardiac MRI, or heart catheterization
- Blood tests and physical examination to assess overall health
Procedure Description
- Administering general anesthesia to ensure the patient is asleep and free of pain.
- Making an incision in the chest to access the heart (traditional open-heart surgery) or through a catheter inserted in the groin (minimally invasive approach).
- Removing the damaged pulmonary valve.
- Sewing the new valve into place.
- Checking the replacement valve to ensure it is functioning correctly.
- Closing the incision with sutures or staples.
Duration
The procedure typically takes 2-4 hours, depending on the complexity and approach.
Setting
Pulmonary valve replacement is performed in a hospital, specifically in an operating room equipped for cardiac surgery.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (in open-heart surgery)
- Cardiologist (may assist in minimally invasive procedures)
Risks and Complications
- Bleeding
- Infection
- Blood clots or stroke
- Valve dysfunction or failure
- Heart rhythm issues (arrhythmias)
- Reaction to anesthesia
- Long-term anticoagulation therapy if a mechanical valve is used
Benefits
- Improved blood flow and heart function
- Relief from symptoms like shortness of breath and fatigue
- Enhanced quality of life
- Potential increase in life expectancy for patients with severe valve disease
Recovery
- Hospital stay of about 5-7 days
- Post-operative care, including pain management and wound care
- Gradual return to normal activities over 6-8 weeks
- Regular follow-up with the cardiologist to monitor valve function
- Possible restrictions on strenuous activities or lifting heavy objects
Alternatives
- Balloon valvuloplasty (less invasive, suitable for certain types of valve stenosis)
- Valve repair instead of replacement
- Medical management with medications to manage symptoms (if surgery is high-risk)
- Pros and cons of alternatives will vary based on patient-specific factors and overall health.
Patient Experience
- During the procedure: The patient will be under general anesthesia and won't feel or remember anything.
- After the procedure: Soreness and discomfort at the incision site, which can be managed with pain medication. The patient may experience fatigue and will progressively regain strength. Regular monitoring and adjustments to medications will be essential for optimal recovery.