sandy06
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PREOPERATIVE DIAGNOSES:
1. Partial anomalous pulmonary venous return in sinus venosus
atrioseptal defect.
2. Chronic obstructive pulmonary disease.
PROCEDURE PERFORMED:
1. Minimally invasive repair of partial anomalous pulmonary venous
return.
2. Sinus stenosis atrioseptal defect utilizing a two pericardial
patch technique with an atrial baffle of the right superior
pulmonary vein through the atrioseptal defect.
3. Enlarging of the superior vena cava and right atrium with a
pericardial patch.
4. Exposure repair of left femoral artery.
OPERATING SURGEON:
ASSISTANTS:
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room, placed in the supine
position, prepped and draped in the usual fashion. A two-team
approach was utilized, one team exposing the left femoral artery and
vein. A Seldinger technique was utilized to cannulate these vessels.
Then, a percutaneous access of the right internal jugular vein was
also performed and an 18-French arterial cannula was placed into the
superior vena cava. Thereafter, a 6 cm skin incision was performed
over the right anterolateral chest wall entering the third interspace
after the lower cartilage was transected to be later reattached. A
soft tissue retractor was placed and a rib spreader. We then
instituted full cardiopulmonary bypass and the pericardium was opened
over the aorta, tacked the skin. Thereafter, superior and inferior
vena cava were encircled vessel loops. It was clearly visualized the
drainage for the superior pulmonary vein into the lower aspect of the
superior vena cava. Thereafter, the aorta was cross clamped. Cold
blood cardioplegia was given both in an antegrade fashion. Note,
retrograde cardioplegia cannula was not utilized. Of note, every 20
minutes further doses of cardioplegia were given. The right atrium
was opened over the superior vena cava and extending down towards the
right atrium. Thereafter, it was clearly visualized that there was a
sinus stenosis atrioseptal defect and drainage of the right upper
pulmonary veins into the superior vena cava so a pericardial patch
was fashion. Utilizing a 5-0 Prolene suture, the patch was sutured
over the pulmonary veins and over the rim of the atrioseptal defect
redirecting the pulmonary vein flow into the left atrium. Thereafter
in order to avoid narrowing of the superior vena cava, another patch
was placed over the superior vena cava and right atrium with a 5-0
Prolene suture in a continuous over-and-over fashion. Thereafter, the
patient was placed in Trendelenburg position. The aortic crossclamp
was removed and then multiple deairing maneuvers were performed
utilizing a Venti needle in the root of the aorta. After adequate
deairing and adequate function of the patch, there was no evidence of
the left to right shunt. The patient was then weaned from
cardiopulmonary bypass. Of note, a ventricular pacing wire was
placed. After weaning from bypass, the venous cannula was removed.
The pursestring suture tied down. Thereafter, the patient was given
protamine which she tolerated well. Then the arterial cannula was
removed and repair left femoral artery performed. In addition, a
pursestring suture was placed in the cervical region and pressure was
applied for half an hour in the cervical region. Thereafter, a right
angle chest tube and a Blake chest tube left; one in the pericardium,
one in the pleural space and the On Q system, the pacing wire were
exited through the chest tube incision. A figure-of-eight suture was
utilized to approximate the rib. Then the rib was reattached back to
the sternum with a FiberWire and small metal plate. The muscle,
subcutaneous tissue, and skin were closed in routine fashion. The
patient tolerated the procedure well with no complications
encountered.
Can someone please give me some insight on this report; I was looking at CPT Code 33724 and 33645.
Thanks in advance.
1. Partial anomalous pulmonary venous return in sinus venosus
atrioseptal defect.
2. Chronic obstructive pulmonary disease.
PROCEDURE PERFORMED:
1. Minimally invasive repair of partial anomalous pulmonary venous
return.
2. Sinus stenosis atrioseptal defect utilizing a two pericardial
patch technique with an atrial baffle of the right superior
pulmonary vein through the atrioseptal defect.
3. Enlarging of the superior vena cava and right atrium with a
pericardial patch.
4. Exposure repair of left femoral artery.
OPERATING SURGEON:
ASSISTANTS:
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room, placed in the supine
position, prepped and draped in the usual fashion. A two-team
approach was utilized, one team exposing the left femoral artery and
vein. A Seldinger technique was utilized to cannulate these vessels.
Then, a percutaneous access of the right internal jugular vein was
also performed and an 18-French arterial cannula was placed into the
superior vena cava. Thereafter, a 6 cm skin incision was performed
over the right anterolateral chest wall entering the third interspace
after the lower cartilage was transected to be later reattached. A
soft tissue retractor was placed and a rib spreader. We then
instituted full cardiopulmonary bypass and the pericardium was opened
over the aorta, tacked the skin. Thereafter, superior and inferior
vena cava were encircled vessel loops. It was clearly visualized the
drainage for the superior pulmonary vein into the lower aspect of the
superior vena cava. Thereafter, the aorta was cross clamped. Cold
blood cardioplegia was given both in an antegrade fashion. Note,
retrograde cardioplegia cannula was not utilized. Of note, every 20
minutes further doses of cardioplegia were given. The right atrium
was opened over the superior vena cava and extending down towards the
right atrium. Thereafter, it was clearly visualized that there was a
sinus stenosis atrioseptal defect and drainage of the right upper
pulmonary veins into the superior vena cava so a pericardial patch
was fashion. Utilizing a 5-0 Prolene suture, the patch was sutured
over the pulmonary veins and over the rim of the atrioseptal defect
redirecting the pulmonary vein flow into the left atrium. Thereafter
in order to avoid narrowing of the superior vena cava, another patch
was placed over the superior vena cava and right atrium with a 5-0
Prolene suture in a continuous over-and-over fashion. Thereafter, the
patient was placed in Trendelenburg position. The aortic crossclamp
was removed and then multiple deairing maneuvers were performed
utilizing a Venti needle in the root of the aorta. After adequate
deairing and adequate function of the patch, there was no evidence of
the left to right shunt. The patient was then weaned from
cardiopulmonary bypass. Of note, a ventricular pacing wire was
placed. After weaning from bypass, the venous cannula was removed.
The pursestring suture tied down. Thereafter, the patient was given
protamine which she tolerated well. Then the arterial cannula was
removed and repair left femoral artery performed. In addition, a
pursestring suture was placed in the cervical region and pressure was
applied for half an hour in the cervical region. Thereafter, a right
angle chest tube and a Blake chest tube left; one in the pericardium,
one in the pleural space and the On Q system, the pacing wire were
exited through the chest tube incision. A figure-of-eight suture was
utilized to approximate the rib. Then the rib was reattached back to
the sternum with a FiberWire and small metal plate. The muscle,
subcutaneous tissue, and skin were closed in routine fashion. The
patient tolerated the procedure well with no complications
encountered.
Can someone please give me some insight on this report; I was looking at CPT Code 33724 and 33645.
Thanks in advance.