Complete repair of anomalous pulmonary venous return (supracardiac, intracardiac, or infracardiac types)
CPT4 code
Name of the Procedure:
Complete Repair of Anomalous Pulmonary Venous Return (Supracardiac, Intracardiac, or Infracardiac Types)
Summary
Complete repair of anomalous pulmonary venous return (TAPVR) is a surgical procedure to correct a congenital heart defect where pulmonary veins are abnormally connected, causing oxygen-rich blood to flow incorrectly. By redirecting the veins to the left atrium, normal blood circulation is restored.
Purpose
The procedure addresses Total Anomalous Pulmonary Venous Return (TAPVR), a condition where pulmonary veins connect to the wrong parts of the heart. The goal is to ensure oxygen-rich blood flows directly into the left atrium, improving oxygen delivery throughout the body.
Indications
- Newborns and infants diagnosed with TAPVR
- Cyanosis (bluish skin due to lack of oxygen)
- Breathing difficulties
- Poor feeding and growth
Preparation
- Fasting for a specified timeframe before surgery
- Medication adjustments as directed by the healthcare provider
- Imaging tests (like echocardiogram or MRI) to assess heart structure
- Blood tests and general health assessment
Procedure Description
- Anesthesia: The patient is given general anesthesia.
- Incision: A cut is made in the chest to access the heart.
- Connection Identification: The surgeon identifies the anomalous connections of the pulmonary veins.
- Redirection: The pulmonary veins are detached from their abnormal positions and reattached to the left atrium.
- Closure: The heart and chest are closed, and the incision is sutured.
Tools include surgical instruments like scalpels, forceps, and clamps; heart-lung bypass machine; imaging technology for guidance.
Duration
Typically 4 to 6 hours.
Setting
Performed in a specialized pediatric cardiac surgery unit within a hospital.
Personnel
- Pediatric cardiac surgeon
- Cardiac anesthesiologist
- Surgical nurses
- Perfusionist (heart-lung bypass machine operator)
- Pediatric cardiologist (for pre- and post-surgery care)
Risks and Complications
- Bleeding
- Infection
- Blood clot formation
- Arrhythmias (irregular heartbeats)
- Pulmonary edema (fluid in the lungs)
- Risk of recurrence or incomplete repair requiring additional surgery
Benefits
- Improved oxygenation and overall blood circulation
- Alleviation of symptoms like cyanosis and breathing difficulties
- Enhanced growth and development in affected infants
Recovery
- Intensive care unit (ICU) monitoring post-surgery
- Pain management with medications
- Gradual resumption of feeding and activities
- Follow-up appointments for echocardiograms and health checks
- Full recovery typically within a few months, with activity restrictions initially
Alternatives
- Partial surgical interventions in high-risk patients
- Medical management with supportive care (though less effective and typically temporary)
Compare to Procedure: While less invasive alternatives exist for temporary relief, complete repair offers a definitive solution but comes with higher immediate risk and longer recovery.
Patient Experience
During the procedure, the patient is under general anesthesia and will be unconscious. Post-surgery, expect soreness and discomfort managed by pain medications. Gradual return to normal activities is expected, and close monitoring ensures complications are managed promptly.