33736 Atrial septectomy or septostomy; open heart with cardiopulmonary bypass

Name of the Procedure:

Atrial Septectomy or Septostomy; Open Heart with Cardiopulmonary Bypass

Summary

This is an open-heart surgical procedure where a hole is created or enlarged in the septum (the wall dividing the left and right atria of the heart). It involves the use of cardiopulmonary bypass, a machine that takes over the function of the heart and lungs during surgery.

Purpose

The procedure is conducted to treat congenital heart defects, particularly those involving the septum. Its primary goal is to improve blood flow and oxygenation in patients with compromised heart function.

Indications

• Severe congenital heart defects (e.g., atrial septal defects, hypoplastic left heart syndrome).
• Conditions causing poor oxygenation of blood.
• Symptomatic cases where other treatments have failed.

Preparation

• Patients are often required to fast for 8-12 hours before the procedure.
• Pre-operative tests include blood work, echocardiograms, and sometimes cardiac MRI.
• Medications might be adjusted. Patients should inform their healthcare provider about all medications they are taking.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A sternotomy (cut through the breastbone) is made to access the heart.
3. Cardiopulmonary Bypass: The heart is connected to a cardiopulmonary bypass machine to maintain blood circulation and oxygenation.
4. Atrial Septostomy: The surgeon creates or enlarges a hole in the atrial septum.
5. Closure: The incisions are closed, and the patient is gradually weaned off the bypass machine.

Duration

The procedure typically lasts between 3 to 5 hours.

Setting

This surgery is performed in a hospital's operating room equipped with advanced cardiovascular surgical facilities.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (operates the cardiopulmonary bypass machine)
• Surgical Technicians

Risks and Complications

• Bleeding
• Infection
• Blood clots
• Heart rhythm problems
• Stroke
• Reaction to anesthesia
• Post-operative heart failure

Benefits

• Enhanced oxygenation of blood
• Improved heart function and patient well-being
• Reduction in symptoms such as shortness of breath and fatigue

Recovery

• Initial recovery in an Intensive Care Unit (ICU) for close monitoring.
• Hospital stay for approximately 1-2 weeks.
• Restrictions on physical activity for several weeks.
• Follow-up appointments for ongoing assessment.
• Pain management with prescribed medications.

Alternatives

• Balloon atrial septostomy (a less invasive procedure).
• Pharmacological management.
• Heart transplantation (in severe cases).

Each alternative has its pros and cons related to invasiveness, recovery time, and suitability based on the patient’s condition.

Patient Experience

Patients can expect significant involvement in terms of anesthesia and surgical intervention. Post-procedure, discomfort and pain are managed with medications. There will be intense monitoring initially, followed by a gradual return to normal activities under medical guidance.