33507 Repair of anomalous (eg, intramural) aortic origin of coronary artery by unroofing or translocation

Name of the Procedure:

Repair of Anomalous Aortic Origin of Coronary Artery by Unroofing or Translocation

Summary

In this procedure, a malformation where a coronary artery abnormally originates from the aorta is corrected. This can involve "unroofing" (removing the abnormal segment) or "translocation" (reimplanting the artery in a normal position).

Purpose

The procedure addresses an abnormal coronary artery connection to the aorta that can impair blood flow, leading to chest pain, fainting, or even sudden cardiac arrest. The goal is to restore normal circulation and reduce the risk of serious cardiac events.

Indications

• Symptoms like chest pain, dizziness, or fainting during physical exertion.
• Evidence from imaging tests indicating an anomalous coronary artery.
• Patients diagnosed with reduced blood flow to the heart muscle due to the anomaly.

Preparation

• Patients may need to fast (no food or drink) for 8-12 hours before the procedure.
• Medications may be adjusted; blood thinners are often paused.
• Diagnostic tests like ECG, echocardiogram, or cardiac MRI are required to visualize the anomaly.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A chest incision is made to access the heart.
3. Unroofing: The inner wall of the aortic artery is carefully cut to redirect the coronary artery to its proper path.
4. Translocation: Alternatively, the coronary artery is detached and reimplanted at a normal location on the aorta.
5. Closure: The incision is closed and the patient is taken off bypass if used.

Duration

The procedure typically takes 3-6 hours, depending on the complexity.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Surgeon: A cardiac surgeon specializes in heart procedures.
• Anesthesiologist: Manages anesthesia and monitors vital signs.
• Surgical Nurses: Assist with the operation and patient care.

Risks and Complications

• Common Risks: Bleeding, infection, reactions to anesthesia.
• Rare Risks: Heart attack, stroke, arrhythmias, or damage to nearby blood vessels.
• Management: Most complications can be managed with medications or additional procedures.

Benefits

• Restored normal blood flow to the heart.
• Reduction or elimination of symptoms like chest pain and fainting.
• Lower risk of sudden cardiac events.

Recovery

• Hospital Stay: 5-7 days for initial recovery.
• Home Care: Avoid strenuous activities for 4-6 weeks.
• Follow-up: Regular cardiac check-ups to monitor progress.
• Medications: Pain relief and potentially short-term blood thinners.

Alternatives

• Observation: For mild symptoms, monitoring without immediate surgery.
• Medication: Drugs to manage symptoms but do not correct the anomaly.
• Pros and Cons: Surgery offers a permanent solution but comes with higher immediate risks compared to medication.

Patient Experience

• During Procedure: The patient is under general anesthesia and will not feel anything.
• After Procedure: Patients may feel soreness and fatigue. Pain is managed with medications.
• Comfort Measures: Hospital staff provides necessary care to ensure comfort and manage pain.