33926 Repair of pulmonary artery arborization anomalies by unifocalization; with cardiopulmonary bypass

Name of the Procedure:

Repair of Pulmonary Artery Arborization Anomalies by Unifocalization with Cardiopulmonary Bypass

Summary

This procedure corrects abnormalities in the branching of the pulmonary arteries by redirecting blood flow to a single, more efficient pathway. Cardiopulmonary bypass (a machine that temporarily takes over the function of the heart and lungs) is used to support the patient during surgery.

Purpose

The primary goal is to improve blood flow from the heart to the lungs, facilitating efficient oxygenation of blood. This helps to alleviate symptoms such as breathlessness and fatigue, and can improve overall cardiac function.

Indications

• Congenital heart defects resulting in abnormal pulmonary artery branching.
• Symptoms like severe breathing difficulties, cyanosis (bluish skin due to lack of oxygen), or recurrent lung infections.
• Patients for whom other, less invasive treatments have been unsuccessful or are inappropriate.

Preparation

• Patients may need to fast (no food or drink) for several hours before the procedure.
• Pre-operative assessments may include blood tests, chest X-rays, echocardiograms, and possibly cardiac catheterization.
• Medication adjustments, particularly blood thinners, will be managed by healthcare providers.

Procedure Description

1. The patient is put under general anesthesia to ensure they are asleep and pain-free.
2. An incision is made in the chest to access the heart and lungs.
3. The cardiopulmonary bypass machine is connected to take over heart and lung functions.
4. The surgeon identifies misaligned or misdirected arteries and carefully redirects blood flow through a single, more efficient pathway (unifocalization).
5. Once the repair is completed, the cardiopulmonary bypass machine is disconnected.
6. The chest is closed and the patient is monitored until they wake up from anesthesia.

Duration

The procedure typically takes between 4 to 6 hours, depending on the complexity of the anomalies.

Setting

This surgery is performed in a hospital operating room, usually equipped with specialized cardiac surgery facilities.

Personnel

• Cardiothoracic Surgeons
• Anesthesiologists
• Surgical Nurses
• Perfusionists (who manage the cardiopulmonary bypass machine)
• Support staff including scrub nurses and technicians

Risks and Complications

• Common risks include infection, bleeding, and reactions to anesthesia.
• Rare risks include stroke, heart attack, or complications from the cardiopulmonary bypass machine.
• Post-operative complications may include arrhythmias, respiratory issues, or need for additional interventions.

Benefits

• Improved blood flow between the heart and lungs.
• Reduced symptoms such as breathlessness and fatigue.
• Enhanced quality of life and potentially longer life expectancy.

Recovery

• Recovery typically involves several days in the Intensive Care Unit (ICU) followed by a stay in a regular hospital room.
• Patients are monitored for signs of infection, proper heart function, and overall recovery.
• Follow-up appointments and possible cardiac rehabilitation will be required.
• Full recovery can take several weeks to a few months, depending on the patient's overall health and the surgery's complexity.

Alternatives

• Medical management with medications to alleviate symptoms.
• Other surgical interventions that may not require unifocalization.
• Palliative care for patients who are too high-risk for surgery.

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel pain.
• Post-procedure, discomfort from the chest incision and general soreness is common but managed with pain medication.
• Gradual increase in activity levels as dictated by the surgical team, with pain and symptom management to ensure comfort.