minimally invasive complex mitral valve repair


Weston, FL
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Severe mitral regurgitation with flail P2 segment of mitral valve and
no evidence of aortic valve pathology by transesophageal echo.
Hybrid procedure status post angioplasty of the right coronary

1. Procedure minimally invasive
complex mitral valve repair utilizing a 32 millimeter 3 dimension
profile annuloplasty ring.
2. Triangular folding plasty of Posterior second and posterior third.
3. Direct repair of right femoral artery.



The patient was taken to the operating room, placed in the supine
position and prepped and draped in the usual fashion. A ____
approach was utilized to expose the left femoral artery and vein. Of
note a Seldinger technique was utilized to cannulate the left femoral
vein, although upon passing the wire in the left femoral artery it
appeared to be an obstruction so a cutdown was performed in the right
femoral artery and then a Seldinger technique was utilized to access
this artery without difficulty. Thereafter a 5-6 cm skin incision
was performed of the right later chest wall. The fourth interspace
was entered and the soft tissue retractor was placed and a rib
spreader of the pericardium was opened over the phrenic nerve and
tacked the skin thereafter a retrograde cardioplegia cannula was
inserted. We had already instituted a full cardiopulmonary bypass.
The aorta was then cross clamped. Occult blood and cardioplegia was
given both in the antegrade and retrograde fashion until obtaining
adequate mechanical heart rate repeated every 20 minutes throughout
the operation. The left lateral atriotomy was performed exposing the
mitral valve. It is noted the patient had myxomatous degeneration of
the mitral valve with a flailed cord of the right lateral aspect of
posterior second. A 2-0 Tevdek sutures placed circumferentially
around the anulus and then at this point the ruptured cord were
transected and then a triangular folding plasty was performed of this
posterior second and posterior third segment without resecting the
segment. Thereafter the anterior leaflet was sized and note to
accommodate a 32 millimeter and 3 dimension profile ring. The ring
was passed onto the operative field. The sutures placed through the
ring. The ring was seated onto the anulus and the sutures tied down
and transected. Thereafter, the left atrium was closed with 4-0
Prolene suture and two layer closure, one ventricular pacing wire was
placed. The patient was placed in Trendelenburg position. The
aortic cross-clamp was removed. The multiple de-airing maneuvers
were performed utilizing a THI needle route of the aorta ectatic of
the area and adequate function of the valve with no evidence of
mitral regurgitation. The patient was then weaned from the
cardiopulmonary bypass. The venous cannula was removed. The purse
sutures tied down. The patient _______ that she tolerated well.
The arterial cannula was removed and the indirect repair of the right
femoral artery was performed. Approximation incision with a two
layer closure. A ____ the pacing wires and a Blake chest tube was
left in the pericardial space and a right angle chest tube and right
pleural space and these were all done through the chest tube
incision. A figure-of-eight suture was utilized to approximate the
ribs and the muscle and subcutaneous tissues and skin were all closed
in a routine fashion. The patient tolerated the procedure and had no

Should I just code for the MVR 33430 and add mod -22; or there's more to this report.

Please help.



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Hi! Proc 33430 is for a Mitral valve replacement..Your surgeon placed a ring so you would NOT use the 33430.

You may also want to look at 33427 -Radical reconstruction. This involves using mutliple repair techniques to reconstruct damage valve, including transfer of cords from the posterior leaflet to the anterior leaflet.

Note that 33427 is with or without ring.. Proc code 33426 is what is used when a Ring is placed.

Hope this helps! :)


Denver CO
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I agree.....the attention to the flail cord in order to correct the function of the leaflets would constitute the use of 33427. And it's definitely a ring replacement and not the whole valve.