33645 Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage

Name of the Procedure:

Direct or Patch Closure for Sinus Venosus Defect, with or without Anomalous Pulmonary Venous Drainage

Summary

This surgical procedure corrects a congenital heart defect called sinus venosus defect, sometimes accompanied by abnormal pulmonary venous drainage. The defect is repaired using direct sutures or a patch to close the hole in the heart’s atrial septum.

Purpose

This procedure addresses the improper connection between the heart's chambers and the veins, which can disrupt normal blood flow. The goal is to restore proper circulation, improving heart function and reducing symptoms like breathlessness and fatigue.

Indications

• Presence of a sinus venosus defect confirmed by diagnostic imaging.
• Symptoms like shortness of breath, fatigue, or frequent respiratory infections.
• Evidence of right atrial or right ventricular enlargement.
• Cases where the defect is large and affects the heart's function.

Preparation

• Fasting for at least 8 hours prior to the surgery.
• Adjustments to medications as advised by the cardiologist.
• Preoperative tests including echocardiogram, chest X-ray, and possibly a cardiac MRI or CT scan.
• Blood tests to check for overall health and anesthesia compatibility.

Procedure Description

1. The patient receives general anesthesia.
2. A chest incision is made to access the heart.
3. Cardiopulmonary bypass is initiated to take over the heart’s function during surgery.
4. The surgeon identifies the sinus venosus defect and observes any anomalous pulmonary venous drainage.
5. The defect is closed using either direct sutures or a synthetic patch.
6. If anomalous pulmonary veins are present, they are redirected to their proper location.
7. The heart is restarted, and the chest is closed with sutures or staples.

Duration

The procedure typically takes 3-5 hours.

Setting

Performed in a hospital's cardiac surgery operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (operates the heart-lung machine)
• Cardiac surgery assistants

Risks and Complications

• Infection
• Bleeding
• Arrhythmias (irregular heartbeats)
• Blood clots
• Residual or recurrent defects
• Complications from anesthesia
• Rarely, damage to heart valves or other structures

Benefits

• Improved heart function and oxygenation of blood
• Reduced symptoms such as shortness of breath and fatigue
• Prevention of long-term complications like heart failure or arrhythmias
• Most benefits realized shortly after recovery, with significant quality-of-life improvements

Recovery

• Hospital stay of about 5-7 days
• Initial recovery includes pain management, monitoring for complications, and gradual return to activity
• Full recovery typically takes 6-8 weeks
• Follow-up visits with a cardiologist to monitor heart function and healing
• Restrictions on heavy lifting and strenuous activities during recovery

Alternatives

• Medical management might include medications to control symptoms, but it does not repair the defect.
• Minimally invasive or catheter-based techniques may be considered in select cases but might not be suitable for all defects.
• Observation and regular monitoring for small, asymptomatic defects.

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel or remember the surgery.
• Postoperative pain is managed with medications.
• Initial discomfort from the chest incision, which improves with time.
• Patients will feel progressively better as they recover, regaining energy and reducing symptoms related to the heart defect.