33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed

Name of the Procedure:

Transcatheter Pulmonary Valve Implantation, Percutaneous Approach (TPVI)

• Also known as Transcatheter Pulmonary Valve Replacement (TPVR) or Percutaneous Pulmonary Valve Implantation (PPVI)

Summary

Transcatheter Pulmonary Valve Implantation is a minimally invasive procedure that replaces a dysfunctional pulmonary valve in the heart through a catheter inserted into a blood vessel. This approach often includes pre-stenting to prepare the valve delivery site for optimal placement.

Purpose

This procedure addresses pulmonary valve dysfunction, which can lead to heart failure, arrhythmias, and other serious complications. The goal is to improve heart function, relieve symptoms, and enhance the patient's quality of life.

Indications

• Severe pulmonary valve stenosis or regurgitation
• Congenital heart defects affecting the pulmonary valve
• Previous surgical valve repair that has failed
• Symptoms such as shortness of breath, fatigue, and heart palpitations

Preparation

• Fasting for 6-8 hours before the procedure
• Adjusting medications, especially anticoagulants
• Undergoing diagnostic tests like echocardiograms, MRI, or CT scans to assess heart and valve anatomy

Procedure Description

1. Anesthesia: General or local anesthesia with sedation is administered.
2. Access: A catheter is inserted through a vein, typically in the groin.
3. Navigation: Using imaging guidance, the catheter is navigated to the heart.
4. Pre-stenting: A stent is placed at the intended valve site to prepare the area.
5. Valve Delivery: The new valve is compressed onto a balloon catheter and positioned within the stent.
6. Deployment: The balloon is inflated, expanding the valve into place.
7. Confirmation: Imaging is used to confirm correct valve placement.

Duration

Approximately 1-3 hours.

Setting

Usually performed in a hospital catheterization lab or specialized cardiac center.

Personnel

• Interventional cardiologists
• Cardiac surgeons
• Anesthesiologists
• Specialized nurses and technicians

Risks and Complications

• Bleeding or infection at the catheter insertion site
• Blood clots or stroke
• Valve malpositioning or failure
• Heart rhythm disturbances
• Complications at the access site, such as hematoma

Benefits

• Immediate improvement in valve function
• Symptom relief typically within days
• Shorter recovery time compared to open-heart surgery

Recovery

• Monitoring in the hospital for 1-2 days
• Gradual return to normal activities over a week or two
• Follow-up appointments to monitor valve function and overall heart health

Alternatives

• Surgical pulmonary valve replacement (open-heart surgery)
  • More invasive with longer recovery time, but may be necessary for specific patients
• Medical management
  • Using medications alone, which may not fully correct the valve dysfunction

Patient Experience

• Minimal discomfort during the procedure due to sedation
• Some soreness at the catheter insertion site post-procedure
• Pain management with medications, if needed
• Gradual resumption of normal activities with no heavy lifting for a short period