Repair sinus of Valsalva aneurysm, with cardiopulmonary bypass
CPT4 code
Name of the Procedure:
Repair Sinus of Valsalva Aneurysm with Cardiopulmonary Bypass
Summary
This surgical procedure repairs a bulge (aneurysm) in the sinus of Valsalva, an area near the aortic valve of the heart. The surgery typically involves the use of a heart-lung machine (cardiopulmonary bypass) to take over the function of the heart and lungs during the procedure.
Purpose
The primary goal is to repair the aneurysm in the sinus of Valsalva to prevent rupture or dissection, which can be life-threatening. Successfully repairing the aneurysm can improve the patient's quality of life and reduce associated risks.
Indications
- Presence of an aneurysm in the sinus of Valsalva, detected via imaging.
- Symptoms such as chest pain, shortness of breath, or other signs of heart failure.
- Risk factors such as connective tissue disorders (e.g., Marfan syndrome), congenital heart defects, or history of infective endocarditis.
Preparation
- Patients may need to fast for a specified period before surgery.
- Medication adjustments may be necessary, particularly blood thinners or medications affecting blood pressure.
- Pre-operative assessments including blood tests, echocardiography, MRI, or CT scans to evaluate the aneurysm.
Procedure Description
- The patient is placed under general anesthesia.
- A median sternotomy (incision through the breastbone) is performed to access the heart.
- Cardiopulmonary bypass is initiated, using a heart-lung machine to maintain circulation and oxygenation.
- The aneurysm is located, and the surgeon carefully repairs or replaces the affected section of the vessel using a graft or patch material.
- Once the repair is complete, the heart is restarted, and the cardiopulmonary bypass is discontinued.
- The chest is closed, and the patient is moved to the intensive care unit for recovery.
Duration
The procedure usually takes about 4 to 6 hours, depending on the complexity of the repair.
Setting
Most commonly performed in a hospital operating room with an adjacent intensive care unit.
Personnel
- Cardiothoracic surgeon
- Cardiac anesthesiologist
- Surgical nurses
- Perfusionist (operates the heart-lung machine)
Risks and Complications
- Infection
- Bleeding
- Stroke or transient ischemic attack (TIA)
- Heart attack
- Arrhythmias (irregular heartbeats)
- Complications related to cardiopulmonary bypass (e.g., clotting or organ dysfunction)
Benefits
- Prevention of aneurysm rupture or dissection
- Relief from associated symptoms
- Improved quality of life and longevity
- Reduction in risk of sudden cardiac events
Recovery
- Hospital stay of about 7-10 days, including ICU care for the first few days post-surgery.
- Pain management with medications.
- Gradual increase in physical activity as recommended by healthcare providers.
- Follow-up appointments for monitoring, including imaging tests to ensure the success of the repair.
- Full recovery may take several weeks to months.
Alternatives
- Non-surgical management with regular monitoring and medications (less viable for severe cases or rapidly growing aneurysms).
- Endovascular repair, though not always possible depending on the aneurysm's location and size.
Patient Experience
- Patients can expect some discomfort post-surgery, managed with pain relief medications.
- Close monitoring in the hospital's ICU initially.
- Gradual return to normal activities with physical therapy and guidance from healthcare providers.
- Emotional support and counseling may be helpful during recovery.