Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve
CPT4 code
Name of the Procedure:
Percutaneous Transcatheter Closure of Paravalvular Leak; Initial Occlusion Device, Mitral Valve
Summary
This procedure involves minimally invasive techniques to place an occlusion device in order to close a paravalvular leak around a previously implanted mitral valve. The process is performed using a catheter that is threaded through a blood vessel to reach the heart.
Purpose
Paravalvular leaks occur when there are gaps or openings around the edges of a prosthetic valve, causing blood to leak backwards. This can lead to symptoms such as heart failure and hemolysis (breakdown of red blood cells). The goal of this procedure is to seal the leak, improve heart function, and alleviate associated symptoms.
Indications
- Symptoms of heart failure (e.g., shortness of breath, fatigue)
- Evidence of hemolysis
- Persistent symptoms despite medical management
- Poor quality of life related to the leak
Preparation
- Fasting for at least 6-8 hours before the procedure
- Discontinuation of certain medications as advised by the healthcare provider
- Comprehensive pre-procedure assessments, including echocardiography, blood tests, and possibly a CT scan
Procedure Description
- The patient is placed under general anesthesia or conscious sedation.
- A catheter is inserted through a blood vessel, typically in the groin, and guided to the heart using imaging techniques like fluoroscopy and echocardiography.
- The occlusion device is deployed through the catheter to seal the paravalvular leak around the mitral valve.
- The position and effectiveness of the device are confirmed using imaging.
- The catheter is removed, and the entry site is closed.
Duration
The procedure typically takes between 1 to 3 hours.
Setting
This procedure is performed in a hospital, specifically in a catheterization lab or a hybrid operating room.
Personnel
- Interventional cardiologists
- Cardiac surgeons
- Anesthesiologists
- Nurses and technologists specialized in cardiac procedures
Risks and Complications
- Bleeding or infection at the catheter insertion site
- Damage to blood vessels or the heart
- Device malposition or embolization (movement of the device)
- Arrhythmias (irregular heartbeats)
- Stroke or transient ischemic attack (TIA)
Benefits
The primary benefit is the resolution of the paravalvular leak, which can improve heart function, reduce symptoms of heart failure, and enhance overall quality of life. Improvements are typically noticed within a few days to weeks.
Recovery
- Close monitoring in a hospital setting for 1-2 days post-procedure
- Instructions to avoid strenuous activities for a few weeks
- Follow-up appointments to assess the success of the procedure and monitor for complications
- Medication adjustments may be necessary
Alternatives
- Continued medical management with medications
- Open surgical repair or replacement of the mitral valve
- Each option has its own risks and benefits, with percutaneous closure being less invasive compared to open surgery.
Patient Experience
During the procedure, the patient may experience mild discomfort but should not feel pain due to sedation or anesthesia. Post-procedure, there may be some soreness at the catheter insertion site and general fatigue. Pain management will be provided to ensure comfort. The patient is usually able to resume normal activities gradually within a few weeks, depending on individual recovery progress.