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Anastomosis, cavopulmonary, second superior vena cava (List separately in addition to primary procedure)
CPT4 code
Name of the Procedure:
Anastomosis, cavopulmonary, second superior vena cava
Summary
This procedure involves connecting a second superior vena cava (a vein that brings deoxygenated blood from the body) to the pulmonary arteries, allowing blood to bypass the heart and flow directly into the lungs for oxygenation. This secondary anastomosis is often done during or after a primary heart surgery.
Purpose
The procedure addresses congenital heart defects or conditions where normal blood flow and oxygenation are compromised. It helps improve oxygen delivery to the body by ensuring efficient blood flow to the lungs.
Indications
- Congenital heart disease requiring staged surgical intervention.
- Presence of a second superior vena cava that needs rerouting.
- Previous heart surgeries that necessitate more effective blood flow adjustments.
Preparation
- Pre-procedure fasting for at least 8 hours.
- Potential adjustment of regular medications, particularly blood thinners.
- Pre-surgical assessments, including blood tests, echocardiogram, and chest X-rays.
Procedure Description
- The patient is placed under general anesthesia.
- A midline incision is made on the chest to access the heart and great vessels.
- Cardiopulmonary bypass may be initiated to maintain circulation during the procedure.
- The second superior vena cava is identified and dissected.
- The vena cava is connected to the pulmonary artery using sutures to create an anastomosis.
- The surgical area is inspected for any leaks or issues.
- The incision is closed, and the patient is taken off cardiopulmonary bypass if used.
- The patient is moved to the recovery area for monitoring.
Duration
Typically takes 3-6 hours, depending on the complexity and the patient's condition.
Setting
The procedure is performed in a hospital's cardiovascular surgery suite.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (if cardiopulmonary bypass is used)
- Surgical technicians
Risks and Complications
- Bleeding
- Infection
- Clot formation
- Lung complications
- Arrhythmias (irregular heartbeats)
- Anastomotic leaks
- Heart failure
Benefits
- Improved oxygenation of the blood.
- Enhanced overall cardiac function and symptom relief.
- Better quality of life post-recovery.
Recovery
- Patients are typically monitored in an ICU for 24-48 hours post-surgery.
- Gradual introduction of physical activity as tolerated.
- Pain management with medications.
- Regular follow-up appointments to monitor heart function.
- Full recovery can take several weeks to months.
Alternatives
- Medication management for symptom control.
- Non-surgical interventions like catheter-based procedures.
- Heart transplantation in extreme cases.
- Each alternative has varying success rates and risks.
Patient Experience
- Patients may experience discomfort or pain at the incision site, managed with pain medication.
- Temporary restriction on physical activities.
- Regular check-ups and possible physical therapy for rehabilitation.
- Emotional support and counseling might be necessary for coping with the recovery phase.