Repair of double outlet right ventricle with intraventricular tunnel repair; with repair of right ventricular outflow tract obstruction
CPT4 code
Name of the Procedure:
Repair of Double Outlet Right Ventricle with Intraventricular Tunnel Repair; with Repair of Right Ventricular Outflow Tract Obstruction
Commonly known as: DORV Repair with IVT and RVOT Obstruction Repair
Summary
This complex surgical procedure corrects congenital heart defects where both main arteries (the aorta and pulmonary artery) arise from the right ventricle. It also addresses any blockages in the right ventricular outflow tract to promote normal blood flow.
Purpose
This surgery fixes the structural abnormalities of the heart to ensure proper separation of oxygen-rich and oxygen-poor blood. The goal is to improve cardiac function and overall oxygenation of the body, ultimately enhancing the patient's quality of life and long-term heart health.
Indications
- Diagnosed Double Outlet Right Ventricle (DORV)
- Right Ventricular Outflow Tract (RVOT) Obstruction
- Symptoms such as cyanosis (bluish skin due to lack of oxygen), shortness of breath, and fatigue
- Ineffective previous treatments or surgeries
Preparation
- Patients must fast for at least 8 hours prior to surgery.
- Medication adjustments may be required; some medications might have to be stopped or modified.
- Preoperative diagnostic tests may include echocardiograms, MRIs, CT scans, and cardiac catheterization.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A median sternotomy (chest incision) is made to access the heart.
- Cardiopulmonary Bypass: The heart is connected to a bypass machine to maintain blood circulation.
- Repair: A synthetic patch creates a tunnel (intraventricular tunnel) inside the heart to reroute the blood flow from the left ventricle to the aorta. The right ventricular outflow tract obstruction is also relieved.
- Closure: The heart is closed, and the bypass machine is gradually removed.
- Monitoring: The patient is closely monitored as they awaken from anesthesia.
Duration
The surgery typically takes between 4 to 6 hours.
Setting
This procedure is performed in a hospital's cardiac surgery operating room.
Personnel
- Cardiothoracic surgeon
- Surgical assistants
- Anesthesiologist
- Perfusionist (for the heart-lung machine)
- Nursing staff specialized in cardiac surgery
Risks and Complications
- Infection
- Bleeding
- Arrhythmias (irregular heartbeats)
- Heart block requiring pacemaker
- Respiratory issues
- Stroke
- Renal (kidney) complications
- Though rare, risk of death
Benefits
- Improved cardiac function
- Better oxygenation of the body
- Enhanced quality of life
- Increased life expectancy
Recovery
- Initial intensive care stay for close monitoring
- Gradual transition to a general cardiac unit
- Hospital stay typically lasts 1 to 2 weeks
- Full recovery may take several months
- Activity restrictions and follow-ups with cardiologists
Alternatives
- Medical management for less severe cases
- Other surgical corrections for specific associated defects
- Palliative procedures for high-risk surgical candidates
- Each alternative has its own risks and benefits compared to full repair surgery
Patient Experience
- Patients may feel sore and tired after surgery.
- Pain is managed with medications.
- Discomfort from chest tubes and breathing tubes initially.
- Emotional support and cardiac rehabilitation are often part of the recovery process.
This text provides a concise yet detailed overview of the procedure tailored to inform and reassure patients, their families, and healthcare providers.