Repair of complete atrioventricular canal, with or without prosthetic valve
CPT4 code
Name of the Procedure:
Repair of complete atrioventricular canal (CAVC), with or without prosthetic valve.
Summary
This surgical procedure involves repairing a congenital heart defect where there is a large hole between the heart's chambers and problems with the valves that control blood flow between the heart's chambers. The surgery may include the use of a prosthetic valve, if necessary, to ensure proper heart function.
Purpose
The procedure addresses a complete atrioventricular canal defect, a condition that can lead to serious complications such as heart failure, poor growth, lung problems, and frequent respiratory infections. The primary goals are to close the gap between the heart's chambers, correct the functioning of the heart valves, and improve the patient's overall heart function.
Indications
- Congenital heart defect diagnosed as complete atrioventricular canal
- Symptoms such as difficulty breathing, poor weight gain, fatigue, and cyanosis (bluish skin)
- Echocardiogram or other diagnostic tests confirming the defect
- Informed decision by the patient’s guardians in case of pediatric patients
Preparation
- Fasting for a specified period before surgery
- Adjustments in medications as advised by the healthcare provider
- Pre-surgery diagnostic tests including echocardiogram, chest X-ray, and blood tests
Procedure Description
- The patient is placed under general anesthesia.
- A surgical incision is made in the chest to access the heart.
- The heart is temporarily stopped, and its function is maintained using a heart-lung bypass machine.
- The surgeon repairs the hole(s) between the heart's chambers using patches.
- The atrioventricular valves are also repaired or replaced if necessary.
- The heart is restarted, the chest is closed, and the patient is transferred to the recovery unit.
Duration
Typically, the procedure takes between 3 to 6 hours, depending on the complexity of the defect and whether a valve replacement is necessary.
Setting
The procedure is performed in a hospital, specifically in a cardiac surgery operating room.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (operates the heart-lung machine)
- Pediatric cardiologist (if appropriate)
Risks and Complications
- Infection
- Bleeding
- Injury to the heart or nearby organs
- Irregular heart rhythms
- Blood clots
- Stroke
- Valve dysfunction post-surgery
- Need for reoperation
Benefits
- Improved heart function
- Enhanced quality of life
- Reduction or elimination of symptoms like fatigue and breathing difficulties
- Better growth and development, especially in children
- Potential for a normal lifespan
Recovery
- Initial recovery in the Intensive Care Unit (ICU) for close monitoring
- Gradual transition to a regular hospital room
- Pain management using medications
- Instructions on wound care, activity limitations, and diet
- Follow-up appointments with a cardiologist
- Full recovery may take several weeks to months
Alternatives
- Medical management with close monitoring (may not be viable for severe cases)
- Delayed surgery if deemed safe by cardiologist
- Palliative procedures to buy time for more definitive surgery
Patient Experience
During surgery, the patient will be under general anesthesia and will not feel any pain. Post-surgery, the patient may experience fatigue, mild pain at the incision site, and some discomfort. Pain will be managed with medications, and hospital staff will provide support to ensure comfort and monitor recovery closely.