Closure of single ventricular septal defect, with or without patch; with pulmonary valvotomy or infundibular resection (acyanotic)
CPT4 code
Name of the Procedure:
Closure of single ventricular septal defect (VSD), with or without patch; with pulmonary valvotomy or infundibular resection (acyanotic)
Summary
This surgical procedure involves closing a hole in the wall (septum) that separates the heart's lower chambers (ventricles). It may also include widening a narrowed pulmonary valve (pulmonary valvotomy) or removing obstructive muscle tissue in the right ventricle (infundibular resection). The procedure is designed for individuals who do not display significant cyanosis (blue discoloration of the skin due to lack of oxygen).
Purpose
This procedure addresses a ventricular septal defect (VSD), a condition where there is an abnormal opening in the septum that allows blood to pass from the left to the right ventricle. The goals are to correct the blood flow through the heart, reduce strain on the heart, and prevent complications such as heart failure or pulmonary hypertension.
Indications
- Presence of a diagnosed ventricular septal defect.
- Significant blood flow from the left to right ventricle due to the defect.
- Symptoms such as breathlessness, poor growth in infants, or frequent respiratory infections.
- Pulmonary valve narrowing or muscle obstruction in the right ventricle causing additional heart strain.
Preparation
- Patients are usually instructed to fast for a specific period before the surgery.
- Medication adjustments may be necessary; patients should inform their healthcare provider about all medications they are taking.
- Pre-procedure assessments include an echocardiogram, EKG, chest X-ray, and blood tests to evaluate overall health and cardiac function.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision and Access: The surgeon makes an incision in the chest and opens the breastbone to access the heart.
- Heart-Lung Machine: The patient is connected to a heart-lung machine to maintain circulation and oxygenation during the procedure.
- VSD Closure: The defect in the septum is closed using either stitches or a patch.
- Pulmonary Valvotomy or Infundibular Resection: If necessary, the pulmonary valve is widened or obstructive muscle tissue is removed.
Completion: The heart is restarted and taken off the heart-lung machine. The chest incision is closed with sutures or staples.
Duration
The procedure typically takes 3 to 5 hours.
Setting
The surgery is performed in a hospital, specifically in a well-equipped operating room with access to advanced cardiac care facilities.
Personnel
- Cardiac Surgeon
- Anesthesiologist
- Surgical Nurses
- Perfusionist (operates the heart-lung machine)
- Cardiologist (may be involved in pre- and post-operative care)
Risks and Complications
- Infection at the incision site
- Excessive bleeding
- Arrhythmias (irregular heartbeats)
- Damage to heart tissues or valves
- Blood clots
- Heart block (requires a pacemaker)
- Stroke or other neurological issues (rare)
Benefits
- Improved heart function and blood flow.
- Reduction of symptoms like breathlessness and fatigue.
- Prevention of long-term complications such as heart failure and pulmonary hypertension.
- Improved quality of life.
Recovery
- Hospital stay of 5 to 7 days, including a few days in the intensive care unit.
- Pain management with prescribed medications.
- Gradual return to normal activities over 4 to 6 weeks.
- Follow-up appointments with the cardiologist and surgeon.
- Activity restrictions, including lifting limitations, until fully healed.
Alternatives
- Medical management with medications to control symptoms.
- Catheter-based interventions for smaller defects or less severe cases.
- Observation in asymptomatic patients with small VSDs not causing significant problems.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, they may experience pain at the incision site, managed with pain relief medications. Discomfort, fatigue, and temporary activity restrictions are expected during recovery. Comprehensive care includes constant monitoring and support to ensure a smooth recovery process.