Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Ligation and takedown of a systemic-to-pulmonary artery shunt (performed in conjunction with a congenital heart procedure).
Summary
In simple terms, this procedure involves closing off and removing a special blood vessel connection (shunt) that was created to help blood flow from the body to the lungs. It's typically done while performing surgery to fix congenital heart defects.
Purpose
This procedure addresses congenital heart defects where a temporary shunt was created to improve blood circulation in newborns and young children. The goal is to remove the shunt once it is no longer needed, usually because the underlying heart defect is being repaired.
Indications
- Congenital heart defects requiring shunt placement, such as Tetralogy of Fallot, Pulmonary Atresia, or Single Ventricle Defects.
- Scheduled comprehensive surgical repair of congenital heart defects.
- Symptoms like cyanosis (bluish skin), poor growth, or difficulty breathing despite the presence of a shunt.
Preparation
- Fasting several hours before surgery.
- Adjustments to regular medications as advised by a doctor.
- Pre-operative blood tests, echocardiograms, and possibly a cardiac MRI or CT scan.
- Consultation with a pediatric cardiologist and anesthesiologist.
Procedure Description
- The patient is placed under general anesthesia.
- A surgical incision is made, typically in the chest.
- Surgeons locate the systemic-to-pulmonary artery shunt.
- The shunt is carefully ligated (tied off) to stop blood flow.
- The shunt is then surgically removed or taken down.
- Any concurrent congenital heart repair procedures are performed.
- The incision is closed, and the patient is moved to the recovery area.
Duration
The procedure typically takes 3-5 hours, but this can vary depending on the complexity of the concurrent congenital heart repair.
Setting
The procedure is performed in a hospital's specialized cardiac surgical operating room.
Personnel
- Cardiothoracic surgeons
- Pediatric cardiologists
- Anesthesiologists
- Surgical nurses
- Perfusionists (heart-lung machine specialists)
Risks and Complications
- Bleeding
- Infection
- Blood clots
- Arrhythmias (irregular heartbeats)
- Respiratory complications
- Rare risks include damage to surrounding structures or incomplete repair of heart defects.
Benefits
- Improved oxygenation and blood flow throughout the body.
- Relief from cyanosis and other symptoms.
- Enhanced overall cardiac function and growth.
- Long-term correction of the congenital heart defect.
Recovery
- Intensive care unit (ICU) monitoring immediately after the surgery.
- Pain management with medication.
- Gradual reintroduction of food and activity.
- Hospital stay varying from a few days to weeks, depending on the patient's condition.
- Follow-up appointments for monitoring heart function and recovery progression.
Alternatives
- Continued use of the shunt with regular monitoring if the patient isn't ready for comprehensive repair.
- Balloon angioplasty or stenting, in some cases, as a less invasive interim measure.
- Palliative care, in certain complex cases where surgical intervention might not be pursued.
Patient Experience
- The patient will be under anesthesia and will not feel the surgery.
- Post-operative discomfort managed with pain medication.
- Gradual return to normal activities with physical therapy.
- Emotional support and counselling for the family may be necessary.