93592 Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (List separately in addition to code for primary procedure)

Name of the Procedure:

Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (List separately in addition to code for primary procedure)

Summary

This procedure is a minimally invasive method to fix leaks around a valve in the heart that was previously repaired or replaced. It involves using a special device to seal the leak through a catheter inserted via the skin.

Purpose

This procedure addresses leaks (paravalvular leaks) around previously implanted heart valves. The goal is to stop the leak to improve heart function, reduce symptoms, and prevent complications such as heart failure or endocarditis.

Indications

• Persistent symptoms like shortness of breath, fatigue, or heart palpitations that suggest a paravalvular leak.
• Evidence of significant leak detected through diagnostic imaging (e.g., echocardiography).
• Patients with increased risk for surgery or those who have failed previous surgical leak closure.

Preparation

• Patients may be required to fast for several hours before the procedure.
• Adjustments to medications, particularly anticoagulants, may be necessary.
• Pre-procedure imaging tests like echocardiography or CT scans to assess the leak.
• Blood tests to evaluate overall health and readiness for the procedure.

Procedure Description

1. Anesthesia: The procedure is usually done under general anesthesia or conscious sedation.
2. Access: A catheter is inserted through a small incision, typically in the groin area.
3. Positioning: The catheter is navigated through the blood vessels to the heart with the aid of imaging techniques.
4. Device Deployment: An occlusion device is placed at the site of the paravalvular leak.
5. Additional Devices: If multiple leaks are present, additional occlusion devices may be placed as needed.
6. Confirmation: The success of the closure is confirmed with imaging before the catheter is removed.

Duration

The procedure usually takes between 2 to 4 hours, depending on the complexity and number of leaks.

Setting

The procedure is performed in a hospital, specifically in a cardiac catheterization lab.

Personnel

• Interventional cardiologist or cardiovascular surgeon
• Anesthesiologist
• Cardiac nurses and technicians

Risks and Complications

• Common risks: bleeding, infection at the catheter site, reaction to anesthesia.
• Rare complications: damage to the heart or blood vessels, device displacement, stroke, arrhythmias.
• Management: Monitoring and immediate intervention for any complications.

Benefits

• Relief from symptoms like shortness of breath and fatigue.
• Improved heart function and overall quality of life.
• Reduced risk of further complications like endocarditis.

Recovery

• Patients are typically monitored in the hospital for 1-2 days.
• Post-procedure care may include pain management, restrictions on physical activity, and follow-up appointments.
• Complete recovery usually occurs within a few weeks, though individual experiences may vary.

Alternatives

• Open-heart surgery for valve repair or replacement, which carries higher risks and a longer recovery period.
• Medical management with medications to control symptoms, which may not be sufficient for all patients.

Patient Experience

• During the procedure: Patients under general anesthesia will not be conscious; those under conscious sedation may feel some pressure but should be comfortable.
• After the procedure: Patients might experience mild discomfort at the catheter insertion site and will receive pain management as needed.
• Overall, patients should see improvement in symptoms relatively soon after the procedure.