conleyclan
Guru
Not sure how to separately code the subaortic membrane. The only code I have for that is 33416, but I am not sure if this is what was done (along with the VSD) Thanks!!
PREOPERATIVE DIAGNOSIS
VENTRICULAR SEPTAL DEFECT
SUBAORTIC MEMBRANE
POSTOPERATIVE DIAGNOSIS
VENTRICULAR SEPTAL DEFECT
SUBAORTIC MEMBRANE
OPERATION
CLOSURE OF VENTRICULAR SEPTAL DEFECT
RESECTION OF SUBAORTIC MEMBRANE
OPERATIVE INDICATIONS
----- has a ventricular septal
defect. Recently, there has seemed to be more prolapse of the aortic valve and
the ventricular septal defect. There is also a question of subaortic membrane
that was confirmed on the transesophageal echocardiogram.
OPERATIVE PROCEDURE
After informed consent was obtained, ---- was brought to the Operating Room and
placed on table in supine position. Anesthesia monitors were attached. General
anesthesia was obtained. ---- chest and abdomen were prepped and draped in the
usual sterile fashion. Midline incision was made and a sternotomy was
performed. The thymus was split, and the pericardium was opened and tacked to
the wound edges. Cannulation sutures were placed in the aorta, superior vena
cava and inferior vena cava. A full heparinizing dose was given. These vessels
were cannulated and cardiopulmonary bypass was instituted. A left ventricular
vent was placed in the right superior pulmonary vein, and tapes were placed
around the SVC and IVC. Dissection was carried out between the aorta and
pulmonary artery. Cardioplegia needle was placed in the aorta. The aorta was
crossclamped, and cardioplegia was administered and the heart arrested
promptly. I opened the right atrium, and I was able to visualize the small
ventricular septal defect that had a lot of fibrous tissue closing it. I was
unable to visualize the membrane through this defect. A Savage patch was cut
to size and sewn in place with running 5 0 Prolene suture. I did place one
annuloplasty suture in the tricuspid valve annulus as well. I tested the
competency of the tricuspid valve and it appeared excellent. The right atrium
was closed with two layers of 5 0 Prolene suture. I then performed an
aortotomy transversely extending it slightly into the noncoronary sinus. I was
able to visualize the significance of subaortic membrane on the anterior
surface around the area of the ventricular septal defect. The subaortic
membrane was resected. Interestingly, the subaortic membrane was what was
tethering the aortic valve, and the aortic valve was freed up as well. The
aorta was closed with two layers of 5 0 Prolene suture, and the aorta was
de-aired. Alaya was placed in the head-down position. The left ventricle was
fully de-aired and the cross-clamp was removed. We had cooled to 32�C and
began rewarming to normothermia. Once we reached normothermia, we weaned from
cardiopulmonary bypass without difficulty. Echocardiogram demonstrated an
excellent result with no residual ventricular septal defect and resolution of
the subaortic membrane. Modified ultrafiltration was performed. Once this was
completed, all the cannula was removed. The pursestrings were tied and each
was reinforced with an additional suture. The sternum was closed with
stainless steel wires, and the skin was closed in two layers, and a Dermabond
dressing was applied. I should also note that atrial and ventricular pacing
wires had been placed as well as a 15-French Blake drain.
PREOPERATIVE DIAGNOSIS
VENTRICULAR SEPTAL DEFECT
SUBAORTIC MEMBRANE
POSTOPERATIVE DIAGNOSIS
VENTRICULAR SEPTAL DEFECT
SUBAORTIC MEMBRANE
OPERATION
CLOSURE OF VENTRICULAR SEPTAL DEFECT
RESECTION OF SUBAORTIC MEMBRANE
OPERATIVE INDICATIONS
----- has a ventricular septal
defect. Recently, there has seemed to be more prolapse of the aortic valve and
the ventricular septal defect. There is also a question of subaortic membrane
that was confirmed on the transesophageal echocardiogram.
OPERATIVE PROCEDURE
After informed consent was obtained, ---- was brought to the Operating Room and
placed on table in supine position. Anesthesia monitors were attached. General
anesthesia was obtained. ---- chest and abdomen were prepped and draped in the
usual sterile fashion. Midline incision was made and a sternotomy was
performed. The thymus was split, and the pericardium was opened and tacked to
the wound edges. Cannulation sutures were placed in the aorta, superior vena
cava and inferior vena cava. A full heparinizing dose was given. These vessels
were cannulated and cardiopulmonary bypass was instituted. A left ventricular
vent was placed in the right superior pulmonary vein, and tapes were placed
around the SVC and IVC. Dissection was carried out between the aorta and
pulmonary artery. Cardioplegia needle was placed in the aorta. The aorta was
crossclamped, and cardioplegia was administered and the heart arrested
promptly. I opened the right atrium, and I was able to visualize the small
ventricular septal defect that had a lot of fibrous tissue closing it. I was
unable to visualize the membrane through this defect. A Savage patch was cut
to size and sewn in place with running 5 0 Prolene suture. I did place one
annuloplasty suture in the tricuspid valve annulus as well. I tested the
competency of the tricuspid valve and it appeared excellent. The right atrium
was closed with two layers of 5 0 Prolene suture. I then performed an
aortotomy transversely extending it slightly into the noncoronary sinus. I was
able to visualize the significance of subaortic membrane on the anterior
surface around the area of the ventricular septal defect. The subaortic
membrane was resected. Interestingly, the subaortic membrane was what was
tethering the aortic valve, and the aortic valve was freed up as well. The
aorta was closed with two layers of 5 0 Prolene suture, and the aorta was
de-aired. Alaya was placed in the head-down position. The left ventricle was
fully de-aired and the cross-clamp was removed. We had cooled to 32�C and
began rewarming to normothermia. Once we reached normothermia, we weaned from
cardiopulmonary bypass without difficulty. Echocardiogram demonstrated an
excellent result with no residual ventricular septal defect and resolution of
the subaortic membrane. Modified ultrafiltration was performed. Once this was
completed, all the cannula was removed. The pursestrings were tied and each
was reinforced with an additional suture. The sternum was closed with
stainless steel wires, and the skin was closed in two layers, and a Dermabond
dressing was applied. I should also note that atrial and ventricular pacing
wires had been placed as well as a 15-French Blake drain.