TWilliam2019
Guru
Operation:
#1. Tricuspid valvectomy
#2. Construction and implantation of CorMatrix tricuspid valve
#3. TEE anesthesia ×2 (pre-bypass and post-bypass)
#4. Temporary cardiopulmonary bypass
male with severe tricuspid valve endocarditis and severe tricuspid valve insufficiency. He is now being taking to the OR for operative therapy.
Operative findings:
#1. TEE pre-bypass: Left ventricular systolic function was normal. Right ventricular size and function were normal. There was severe tricuspid valve insufficiency with a large valve vegetation. and moderate mitral stenosis. There was important calcification of the anterior leaflet of the mitral valve. There was no evidence of vegetations on the mitral valve or aortic valve. The aortic valve was competent. The left atrial appendage was free of thrombi.
#2. TEE post bypass independent interpretation: The CorMatrix neo-tricuspid valve was well-seated with no perivalvular leaks. There was mild central insufficiency all other findings were were identical to the pre-bypass assessment
#3. Operative findings: There was a large vegetation involving the anterior leaflet with subtotal destruction of that leaflet. The septal leaflet also had severe vegetative processes. No evidence of root abscess.
Description of operation:
The patient was placed on the operating table in a supine position and general anesthesia was administered monitoring the arterial pressure, pulmonary artery pressure, electrocardiogram, and the oxygen saturation. The entire chest, abdomen, and legs were prepped and draped in a sterile manner. The TEE probe was placed by anesthesia and findings are described above. A primary median sternotomy was performed and the pericardium was opened and marsupialized. PA-C functioned as the first assistant providing assistance with construction of the neotricuspid valve, exposure, suctioning, following sutures, and cannulation of the heart. Heparinization was carried out and aortic and bi-caval pursestring sutures were placed. CorMatrix patch was placed in saline for 10 minutes. Following this the neotricuspid valve was created by following strict measurement guidance. The cylinder was created with a running double suture of 5-0 Prolene. Ffollowing satisfactory heparinization as measured by ACT greater than 450 seconds aortic and bi-caval cannulation were effected and cardiopulmonary bypass was established. .The aorta was crossclamped and cold sanguinous cardioplegia was infused into the aortic root and diastolic arrest promptly ensued. Additional myocardial protection was achieved using topical slush. The caval tourniquets were tightened. The right atrium was opened in an oblique manner and exposure of the tricuspid valve was achieved. Findings are described above. The tricuspid valve was excised. Pledgeted 4-0 Prolene sutures were placed with pledgets on either side of the papillary muscle for the anterior, and lateral leaflets. The CorMatrix tube valve was brought into position and the 4-0 Prolene sutures were passed through the tube at the edge with 120 degrees spacing and tied and cut. Spacing appeared to be satisfactory. The inflow portion of the neovalve was then secured to the tricuspid valve annulus with 3 equally spaced pledgeted sutures. This then facilitated the running 4-0 Prolene suture to secure the new valve to the tricuspid valve annulus. Saline injection revealed a competent valve and rewarming was carried out. The right atrium was closed with 4-0 Prolene. The caval tourniquets were released the aortic cross-clamp was released and rewarming was continued. Spontaneous sinus rhythm ensued. Cardiopulmonary bypass was then completely discontinued in a gradual manner and satisfactory hemodynamics ensued. Ventricular pacing wires were placed. TEE findings are described above. Protamine was administered ,decannulation was effected and hemostasis was obtained. With satisfactory hemodynamics, sinus rhythm, and hemostasis the chest was closed in layers. PA-C performed the sternal wound closure. A sterile Dermabond dressing was applied, sponge count x 2 was correct, and the patient was then transported to the CVRU in stable condition.
would this be 33465 22
#1. Tricuspid valvectomy
#2. Construction and implantation of CorMatrix tricuspid valve
#3. TEE anesthesia ×2 (pre-bypass and post-bypass)
#4. Temporary cardiopulmonary bypass
male with severe tricuspid valve endocarditis and severe tricuspid valve insufficiency. He is now being taking to the OR for operative therapy.
Operative findings:
#1. TEE pre-bypass: Left ventricular systolic function was normal. Right ventricular size and function were normal. There was severe tricuspid valve insufficiency with a large valve vegetation. and moderate mitral stenosis. There was important calcification of the anterior leaflet of the mitral valve. There was no evidence of vegetations on the mitral valve or aortic valve. The aortic valve was competent. The left atrial appendage was free of thrombi.
#2. TEE post bypass independent interpretation: The CorMatrix neo-tricuspid valve was well-seated with no perivalvular leaks. There was mild central insufficiency all other findings were were identical to the pre-bypass assessment
#3. Operative findings: There was a large vegetation involving the anterior leaflet with subtotal destruction of that leaflet. The septal leaflet also had severe vegetative processes. No evidence of root abscess.
Description of operation:
The patient was placed on the operating table in a supine position and general anesthesia was administered monitoring the arterial pressure, pulmonary artery pressure, electrocardiogram, and the oxygen saturation. The entire chest, abdomen, and legs were prepped and draped in a sterile manner. The TEE probe was placed by anesthesia and findings are described above. A primary median sternotomy was performed and the pericardium was opened and marsupialized. PA-C functioned as the first assistant providing assistance with construction of the neotricuspid valve, exposure, suctioning, following sutures, and cannulation of the heart. Heparinization was carried out and aortic and bi-caval pursestring sutures were placed. CorMatrix patch was placed in saline for 10 minutes. Following this the neotricuspid valve was created by following strict measurement guidance. The cylinder was created with a running double suture of 5-0 Prolene. Ffollowing satisfactory heparinization as measured by ACT greater than 450 seconds aortic and bi-caval cannulation were effected and cardiopulmonary bypass was established. .The aorta was crossclamped and cold sanguinous cardioplegia was infused into the aortic root and diastolic arrest promptly ensued. Additional myocardial protection was achieved using topical slush. The caval tourniquets were tightened. The right atrium was opened in an oblique manner and exposure of the tricuspid valve was achieved. Findings are described above. The tricuspid valve was excised. Pledgeted 4-0 Prolene sutures were placed with pledgets on either side of the papillary muscle for the anterior, and lateral leaflets. The CorMatrix tube valve was brought into position and the 4-0 Prolene sutures were passed through the tube at the edge with 120 degrees spacing and tied and cut. Spacing appeared to be satisfactory. The inflow portion of the neovalve was then secured to the tricuspid valve annulus with 3 equally spaced pledgeted sutures. This then facilitated the running 4-0 Prolene suture to secure the new valve to the tricuspid valve annulus. Saline injection revealed a competent valve and rewarming was carried out. The right atrium was closed with 4-0 Prolene. The caval tourniquets were released the aortic cross-clamp was released and rewarming was continued. Spontaneous sinus rhythm ensued. Cardiopulmonary bypass was then completely discontinued in a gradual manner and satisfactory hemodynamics ensued. Ventricular pacing wires were placed. TEE findings are described above. Protamine was administered ,decannulation was effected and hemostasis was obtained. With satisfactory hemodynamics, sinus rhythm, and hemostasis the chest was closed in layers. PA-C performed the sternal wound closure. A sterile Dermabond dressing was applied, sponge count x 2 was correct, and the patient was then transported to the CVRU in stable condition.
would this be 33465 22