Repair of pulmonary artery stenosis by reconstruction with patch or graft
CPT4 code
Name of the Procedure:
Repair of Pulmonary Artery Stenosis by Reconstruction with Patch or Graft
Summary
This procedure involves surgically widening a narrowed pulmonary artery using a patch or graft material. The goal is to improve blood flow from the heart to the lungs, reducing strain on the heart and enhancing oxygenation of the blood.
Purpose
Medical Condition: Pulmonary artery stenosis, a condition where the pulmonary artery is narrowed, inhibiting blood flow from the heart to the lungs. Goals: To relieve obstruction, reduce symptoms, and improve overall heart and lung function by restoring normal blood flow.
Indications
- Severe or symptomatic pulmonary artery stenosis
- Patients experiencing shortness of breath, chest pain, or fatigue due to reduced blood flow to the lungs
- Criteria may include echocardiographic evidence of significant stenosis or pressure gradients across the narrowed segment.
Preparation
- Patients may need to fast for 6-8 hours before the procedure.
- Medication adjustments might be necessary, including stopping blood thinners.
- Pre-procedure assessments like echocardiograms, cardiac MRI, or CT scans to evaluate the severity and precise location of the stenosis.
Procedure Description
- The patient is placed under general anesthesia.
- A surgeon makes an incision to access the heart and pulmonary artery.
- The narrowed section of the pulmonary artery is identified.
- A patch (often made from synthetic material or a graft from the patient's tissue) is sewn into place to widen the artery.
- The area is checked for leaks and secured.
- The chest incision is closed, and the patient is taken to recovery.
Tools and Equipment:
- Surgical instruments
- Synthetic patches or tissue grafts
- Monitoring equipment
Anesthesia: General anesthesia is administered.
Duration
The procedure typically takes about 3-4 hours.
Setting
Performed in a hospital setting, specifically in a cardiothoracic surgical suite.
Personnel
- Cardiothoracic surgeon
- Surgical nurses
- Anesthesiologist
- Perfusionist (if cardiopulmonary bypass is necessary)
- Operating room technicians
Risks and Complications
- Common Risks: Infection, bleeding, blood clots
- Rare Risks: Heart attack, stroke, arrhythmias, graft/patch failure
- Management strategies include monitoring, medication administration, or additional surgeries if needed.
Benefits
- Improved blood flow from heart to lungs
- Reduced symptoms like shortness of breath and fatigue
- Enhanced heart and lung function, generally noticeable within weeks post-surgery.
Recovery
- Initial hospital stay of 5-7 days.
- Pain management including medication.
- Gradual return to normal activities over 4-6 weeks.
- Follow-up appointments to monitor heart function and wound healing.
- Potential restrictions on strenuous activity during the initial recovery period.
Alternatives
- Balloon angioplasty with or without stent placement: Minimally invasive but may not be suitable for all cases.
- Medical management: Using medications to manage symptoms, though this does not correct the stenosis.
- Pros and Cons: Alternatives may offer a shorter recovery but might not achieve as lasting or effective results in severe cases of stenosis.
Patient Experience
- During: Patients will be under general anesthesia, so they will not feel or be aware of the procedure.
- After: Patients might experience pain or discomfort at the incision site, managed with medications. They may also feel tired and need assistance with daily activities initially.