Repair of anomalous coronary artery from pulmonary artery origin; by graft, with cardiopulmonary bypass
CPT4 code
Name of the Procedure:
Repair of anomalous coronary artery from pulmonary artery origin (Common name: ALCAPA repair); by graft, with cardiopulmonary bypass.
Summary
This surgery corrects a rare congenital heart defect where one of the coronary arteries, which supplies blood to the heart, originates from the pulmonary artery instead of the aorta. During the procedure, a graft is used to reroute the anomalous artery, and a cardiopulmonary bypass machine temporarily takes over the heart's function.
Purpose
People with ALCAPA can suffer from reduced blood flow to the heart muscle, leading to heart failure or sudden cardiac arrest. The goal of the procedure is to restore normal blood flow to the heart muscle, improving heart function and preventing severe complications.
Indications
- Symptoms of heart failure (shortness of breath, fatigue, poor feeding in infants)
- Documented anomaly through imaging studies like echocardiography or coronary angiography
- Reduced cardiac function or ischemia revealed in cardiovascular tests
Preparation
- Fasting for 8-12 hours before surgery
- Discontinuation of certain medications as directed by the healthcare provider
- Complete preoperative tests such as blood tests, echocardiography, and electrocardiogram (ECG)
- Counseling and consent from the patient or guardians
Procedure Description
- Administration of general anesthesia to ensure the patient is unconscious and pain-free.
- An incision is made in the chest to access the heart.
- A cardiopulmonary bypass machine is connected to take over the heart and lung functions.
- The anomalous coronary artery is located.
- A graft is created using a piece of blood vessel, and it's used to reroute the coronary artery from the pulmonary artery to the correct position on the aorta.
- The graft is secured, ensuring proper blood flow.
- The heart is restarted, and the cardiopulmonary bypass machine is removed.
- The chest incision is closed.
Duration
The procedure typically takes between 4 to 6 hours.
Setting
The procedure is performed in a hospital's cardiac surgery operating room.
Personnel
- Cardiothoracic surgeon
- Surgical nurses
- Anesthesiologist
- Perfusionist (specialist in managing the cardiopulmonary bypass machine)
- Cardiologist (for preoperative and postoperative care)
Risks and Complications
- Infection at the site of incision
- Bleeding or blood clots
- Irregular heart rhythms (arrhythmias)
- Reduced heart function or heart failure
- Complications related to anesthesia
- Rare cases of stroke or heart attack
Benefits
- Improved blood flow to the heart muscle
- Better cardiac function
- Reduced symptoms of heart failure
- Increased life expectancy and quality of life
Recovery
- Initial recovery in the Intensive Care Unit (ICU) for close monitoring
- Hospital stay of around 1-2 weeks
- Gradual return to normal activities over several weeks to months
- Follow-up appointments with a cardiologist
- Possible medications to support heart function and prevent complications
Alternatives
- Medical management for symptoms, though not curative
- Less invasive catheter-based interventions, though efficacy is limited in such cases
Patient Experience
During the procedure, the patient will be under general anesthesia. Postoperatively, they may experience:
- Chest discomfort managed by pain medications
- Temporary soreness at the incision site
- Some physical limitations during the initial recovery period
- Gradual regaining of strength and physical abilities with prescribed rehabilitation
Pain management and comfort measures will be provided as per the patient's needs during recovery.