Closure of multiple ventricular septal defects; with pulmonary valvotomy or infundibular resection (acyanotic)
CPT4 code
Name of the Procedure:
Closure of Multiple Ventricular Septal Defects with Pulmonary Valvotomy or Infundibular Resection (Acyanotic)
Summary
In this surgical procedure, a surgeon repairs multiple holes (ventricular septal defects) in the wall separating the heart's lower chambers. Additionally, the surgeon addresses any narrowing (stenosis) in the pulmonary valve or the right ventricular outflow tract to improve blood flow from the heart to the lungs.
Purpose
This procedure addresses congenital heart defects that cause improper blood flow within the heart and to the lungs. The goal is to prevent complications like heart failure, reduce symptoms (e.g., shortness of breath, frequent respiratory infections), and allow the heart and lungs to function more efficiently.
Indications
- Presence of multiple ventricular septal defects (VSDs).
- Symptoms such as difficulty breathing, poor growth, or frequent lung infections.
- Diagnosed pulmonary valve stenosis or infundibular stenosis.
- Lack of cyanosis (i.e., the patient has normal oxygen levels without blue discoloration).
Preparation
- Fasting for 8-12 hours prior to surgery.
- Adjustment or discontinuation of certain medications (as advised by the healthcare provider).
- Pre-operative diagnostic tests such as echocardiography, MRI, or cardiac catheterization to assess heart function and anatomy.
Procedure Description
- The patient is given general anesthesia to ensure they are asleep and pain-free.
- The surgeon makes an incision in the chest to access the heart.
- The heart is temporarily stopped, and blood is circulated using a heart-lung machine.
- The surgeon identifies and patches the ventricular septal defects using synthetic material or tissue grafts.
- If necessary, the surgeon performs a valvotomy to open the pulmonary valve or removes any obstructive muscle tissue (infundibular resection) to improve blood flow.
- The heart is restarted, and the chest incision is closed.
Duration
The procedure typically takes 4 to 6 hours.
Setting
The procedure is performed in a hospital operating room, specifically in a cardiac surgery suite.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (operates the heart-lung machine)
- Cardiac intensivist or surgeon for post-operative care
Risks and Complications
- Infection
- Bleeding
- Arrhythmias (irregular heartbeats)
- Stroke
- Post-operative heart dysfunction
- Blood clots
- Complications from anesthesia
Benefits
- Enhanced quality of life with improved symptoms.
- Prevention of further heart damage and complications.
- Increased life expectancy.
- Immediate and significant improvement in heart and lung function.
Recovery
- Hospital stay for 5 to 10 days post-procedure.
- Pain management with medications.
- Restricted physical activity for several weeks.
- Regular follow-up appointments to monitor heart function.
- Gradual return to normal activities within 6 to 8 weeks.
Alternatives
- Medications to manage symptoms (though this does not repair defects).
- Less invasive procedures (if only one VSD or mild stenosis is present).
- Consideration of whether the risks of surgery outweigh the benefits.
Patient Experience
- Patients will not feel anything during the surgery due to general anesthesia.
- Post-operative pain, managed with medications.
- Gradual return to everyday activities, with some initial discomfort and restrictions on activity.
- Continuous follow-up to ensure successful recovery.