33665 Repair of intermediate or transitional atrioventricular canal, with or without atrioventricular valve repair

Name of the Procedure:

Repair of Intermediate or Transitional Atrioventricular Canal (AV Canal) with or without Atrioventricular Valve Repair
Common name: AV Canal Repair
Technical name: Atrioventricular Septal Defect (AVSD) Repair

Summary

In layman's terms, this procedure is a surgical intervention to fix a congenital heart defect related to the abnormal development of the heart's septum and valves. The focus is on repairing the central part of the heart where the walls between the chambers are incomplete or the valves are not functioning properly.

Purpose

This procedure addresses intermediate or transitional atrioventricular canal defects, which involve abnormalities in the heart's septum and the atrioventricular (AV) valves. The goal is to close the septal defects and ensure the valves function normally, improving blood flow and reducing the strain on the heart.

Indications

• Symptoms of heart failure such as difficulty breathing, poor growth in infants, or fatigue.
• Echocardiogram evidence of AV canal defects.
• Congenital heart defects leading to issues with the heart’s septa and valves.
• Inefficient blood flow through the heart, causing oxygen-poor blood to mix with oxygen-rich blood.

Preparation

• Fasting: Patients typically need to fast for 6-8 hours before the procedure.
• Medication adjustment: Certain medications might be paused or adjusted as advised by the healthcare provider.
• Diagnostic tests: Preoperative assessments including echocardiogram, electrocardiogram (ECG), chest X-ray, and possible cardiac catheterization.

Procedure Description

1. Anesthesia: The patient receives general anesthesia to ensure they are unconscious and pain-free.
2. Incision: A midline incision is made along the chest, and the breastbone is divided to access the heart.
3. Cardiopulmonary Bypass: The patient’s blood is diverted through a heart-lung machine to maintain circulation and oxygenation while the heart is stopped.
4. Defect Repair: Using patches or sutures, the surgeon closes the defects in the septum between the heart's chambers.
5. Valve Repair: If necessary, the atrioventricular valves are either repaired or replaced to ensure proper function.
6. Closure: After the repair, the heart is restarted, the bypass is discontinued, and the chest incision is closed with sutures or staples.

Duration

The procedure typically takes about 4-6 hours, depending on the complexity of the repair needed.

Setting

Performed in a hospital, specifically in an operating room equipped for cardiac surgery.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (operates the heart-lung machine)
• Scrub and Circulating Nurses

Risks and Complications

• Bleeding
• Infection
• Arrhythmias (irregular heartbeats)
• Residual or recurrent septal defects
• Valve dysfunction or leakage
• Adverse reactions to anesthesia
• In rare cases, stroke or heart attack

Benefits

• Improved heart function
• Better blood flow and oxygenation
• Reduced symptoms of heart failure
• Enhanced growth and development in pediatric patients
• Generally, patients see benefits within weeks to months post-surgery.

Recovery

• Intensive Care Unit (ICU) stay for monitoring immediately post-surgery.
• Gradual increase in activity level.
• Pain management with medications.
• Follow-up appointments to monitor heart function and recovery.
• Limited physical activity for several weeks.

Alternatives

• Medical management with medications (temporary and often less effective).
• Catheter-based interventions (not typically sufficient for this type of defect).
• Palliative care for symptom relief without surgical correction (considered in high-risk cases).

Patient Experience

Patients will be under general anesthesia and will not feel pain during the surgery. Postoperatively, there will be an initial period in the ICU, and patients might experience discomfort at the incision site, managed with pain medication. During recovery, patients may feel tired and will need to limit physical activities, gradually resuming normal activities as they heal. Regular follow-up is essential to check the success of the surgery and monitor heart function.