conleyclan
Guru
Hello,
I think I have asked this question before. If the physician places a monocusp gore-tex pulmonary valve, is that 33475? I have included the entire report for help on any part .. Thank you !!
PREOPERATIVE DIAGNOSES: Subaortic stenosis, free pulmonary insufficiency,
residual ventricular septal defect, status post repair of complete
atrioventricular canal defect with tetralogy of Fallot.
POSTOPERATIVE DIAGNOSES: Subaortic stenosis, free pulmonary insufficiency,
residual ventricular septal defect, status post repair of complete
atrioventricular canal defect with tetralogy of Fallot.
PROCEDURES PERFORMED:
1. Redo sternotomy with lysis of adhesions and removal of deep-seated
sternal wires.
2. Resection of subaortic stenosis.
3. Primary closure of this residual ventricular septal defect.
4. Placement of pulmonary valve (Gore-Tex monocusp).
5. Main pulmonary artery patch augmentation.
INDICATIONS FOR THE PROCEDURE: has developed significant subaortic
obstruction and comes to the OR for surgical repair. The patient was also
noted to have a small residual VSD and free pulmonary insufficiency.
OPERATIVE FINDINGS: The patient was found to have a tunnel like
obstruction of the left ventricular outflow tract. There was fibrose and
muscular obstruction. The patient had in essence no pulmonary valve tissue
in the right ventricular outflow tract. There was a tiny residual VSD just
below the commissure opposed between the none and the right coronary cusps.
OPERATIVE TECHNIQUE: With the patient in supine position under excellent
general anesthesia, the chest and abdomen were prepped and draped in the
standard fashion. The chest was entered through the previous median
sternotomy incision. The previous sternal wires were deeply embedded in
the sternum. The wires were cut and removed. The sternum was then divided
using the oscillating saw. The undersurface of each hemisternum was then
carefully dissected from the underlying mediastinal structures. The chest
retractor was then placed and opened. The epicardium of the heart was then
carefully dissected from the pericardium circumferentially. Pursestring
sutures were placed in the distal ascending aorta, SVC, and IVC.
Intravenous heparin was given. The heart was then cannulated in the
standard fashion. Cardiopulmonary bypass was instituted and the patient
was cooled down to 35 degrees Centigrade. An antegrade cardioplegia
catheter was placed in the ascending aorta. Tourniquets were placed around
both caval cannulas. The aorta was then cross-clamped and the heart
arrested using cold antegrade blood cardioplegia, which was administered
approximately every 20-30 minutes. An LV vent was placed through the right
superior pulmonary vein. I first proceeded to open the proximal aorta
through a transverse aortotomy. The aortic valve leaflets were identified
and appeared to be normal. In the subaortic area, there was a tunnel like
obstruction, but approximately about a centimeter below the valve, there
was circumferential fibromuscular membrane. There was a lot of fibrosis
adjacent to the VSD patch also. I very aggressively proceeded to resect
the fibromuscular obstruction from the left ventricular outflow tract. I
aggressively resected the anterolateral muscle and the left ventricular
outflow tract. During my resection, I did create a small VSD at the level
of the intraventricular septum. I also found a small residual VSD, which
had been previously noted preoperatively. This specific VSD was located
just below the commissural post between the right and noncoronary cusp.
This VSD was closed primarily using a 6-0 Prolene in a figure-of-eight
fashion. I then proceeded to open the previous transannular patch in the
right ventricular outflow tract. There was just very small pulmonary valve
tissue posteriorly present. I proceeded to identify the VSD that I had
created during the resection of the left ventricular outflow tract
obstruction. This VSD was easily identified in the distal right
ventricular outflow tract and it was closed using a pledgeted 5-0 Prolene
suture. A separate 5-0 Prolene was then placed for added security. I then
proceeded to place a monocusp Gore-Tex pulmonary valve, which was sewn to
the distal right ventricular outflow tract using the 5-0 Prolene in a
running fashion. I then proceeded to augment the main pulmonary artery
using a patch of Gore-Tex material, which was sewn in place using a 5-0
Prolene in a running fashion. The aortotomy was also closed using a 5-0
Prolene in a 2-layer fashion. CoSeal glue was applied to all suture lines.
The patient was placed in the Trendelenburg position. The antegrade
cardioplegia catheter was used as an aortic root vent. The aortic
cross-clamp was then removed. The heart resumed normal sinus rhythm.
Temporary atrial and ventricular pacing wires were placed. Once fully
warmed, the LV vent was removed. There was good biventricular function
with no residual left ventricular outflow tract obstruction. No
significant residual VSDs were identified. The patient was weaned from
cardiopulmonary bypass without any difficulty. Modified ultrafiltration
was performed. The heart was then decannulated. The pursestring sutures
were tied and the cannulation sites reinforced using 4-0 Prolene suture.
Careful hemostasis was obtained. Mediastinal chest tube was placed. The
incision was then closed in layers. I was present during the whole
procedure.
I think I have asked this question before. If the physician places a monocusp gore-tex pulmonary valve, is that 33475? I have included the entire report for help on any part .. Thank you !!
PREOPERATIVE DIAGNOSES: Subaortic stenosis, free pulmonary insufficiency,
residual ventricular septal defect, status post repair of complete
atrioventricular canal defect with tetralogy of Fallot.
POSTOPERATIVE DIAGNOSES: Subaortic stenosis, free pulmonary insufficiency,
residual ventricular septal defect, status post repair of complete
atrioventricular canal defect with tetralogy of Fallot.
PROCEDURES PERFORMED:
1. Redo sternotomy with lysis of adhesions and removal of deep-seated
sternal wires.
2. Resection of subaortic stenosis.
3. Primary closure of this residual ventricular septal defect.
4. Placement of pulmonary valve (Gore-Tex monocusp).
5. Main pulmonary artery patch augmentation.
INDICATIONS FOR THE PROCEDURE: has developed significant subaortic
obstruction and comes to the OR for surgical repair. The patient was also
noted to have a small residual VSD and free pulmonary insufficiency.
OPERATIVE FINDINGS: The patient was found to have a tunnel like
obstruction of the left ventricular outflow tract. There was fibrose and
muscular obstruction. The patient had in essence no pulmonary valve tissue
in the right ventricular outflow tract. There was a tiny residual VSD just
below the commissure opposed between the none and the right coronary cusps.
OPERATIVE TECHNIQUE: With the patient in supine position under excellent
general anesthesia, the chest and abdomen were prepped and draped in the
standard fashion. The chest was entered through the previous median
sternotomy incision. The previous sternal wires were deeply embedded in
the sternum. The wires were cut and removed. The sternum was then divided
using the oscillating saw. The undersurface of each hemisternum was then
carefully dissected from the underlying mediastinal structures. The chest
retractor was then placed and opened. The epicardium of the heart was then
carefully dissected from the pericardium circumferentially. Pursestring
sutures were placed in the distal ascending aorta, SVC, and IVC.
Intravenous heparin was given. The heart was then cannulated in the
standard fashion. Cardiopulmonary bypass was instituted and the patient
was cooled down to 35 degrees Centigrade. An antegrade cardioplegia
catheter was placed in the ascending aorta. Tourniquets were placed around
both caval cannulas. The aorta was then cross-clamped and the heart
arrested using cold antegrade blood cardioplegia, which was administered
approximately every 20-30 minutes. An LV vent was placed through the right
superior pulmonary vein. I first proceeded to open the proximal aorta
through a transverse aortotomy. The aortic valve leaflets were identified
and appeared to be normal. In the subaortic area, there was a tunnel like
obstruction, but approximately about a centimeter below the valve, there
was circumferential fibromuscular membrane. There was a lot of fibrosis
adjacent to the VSD patch also. I very aggressively proceeded to resect
the fibromuscular obstruction from the left ventricular outflow tract. I
aggressively resected the anterolateral muscle and the left ventricular
outflow tract. During my resection, I did create a small VSD at the level
of the intraventricular septum. I also found a small residual VSD, which
had been previously noted preoperatively. This specific VSD was located
just below the commissural post between the right and noncoronary cusp.
This VSD was closed primarily using a 6-0 Prolene in a figure-of-eight
fashion. I then proceeded to open the previous transannular patch in the
right ventricular outflow tract. There was just very small pulmonary valve
tissue posteriorly present. I proceeded to identify the VSD that I had
created during the resection of the left ventricular outflow tract
obstruction. This VSD was easily identified in the distal right
ventricular outflow tract and it was closed using a pledgeted 5-0 Prolene
suture. A separate 5-0 Prolene was then placed for added security. I then
proceeded to place a monocusp Gore-Tex pulmonary valve, which was sewn to
the distal right ventricular outflow tract using the 5-0 Prolene in a
running fashion. I then proceeded to augment the main pulmonary artery
using a patch of Gore-Tex material, which was sewn in place using a 5-0
Prolene in a running fashion. The aortotomy was also closed using a 5-0
Prolene in a 2-layer fashion. CoSeal glue was applied to all suture lines.
The patient was placed in the Trendelenburg position. The antegrade
cardioplegia catheter was used as an aortic root vent. The aortic
cross-clamp was then removed. The heart resumed normal sinus rhythm.
Temporary atrial and ventricular pacing wires were placed. Once fully
warmed, the LV vent was removed. There was good biventricular function
with no residual left ventricular outflow tract obstruction. No
significant residual VSDs were identified. The patient was weaned from
cardiopulmonary bypass without any difficulty. Modified ultrafiltration
was performed. The heart was then decannulated. The pursestring sutures
were tied and the cannulation sites reinforced using 4-0 Prolene suture.
Careful hemostasis was obtained. Mediastinal chest tube was placed. The
incision was then closed in layers. I was present during the whole
procedure.