CPT® Code 0167T

Deleted

1. Indications

The transmyocardial transcatheter closure of a ventricular septal defect (VSD) with implant is indicated for specific clinical scenarios, including:

• Congenital Defects Repair of congenital ventricular septal defects that may lead to significant hemodynamic compromise.
• Acute Ventricular Septal Rupture Management of acute ventricular septal rupture following a myocardial infarction, which can occur due to ischemic damage to the heart muscle.

2. Procedure

The procedure for transmyocardial transcatheter closure of a VSD with implant involves several critical steps:

• Accessing the Vascular System The procedure begins with the cannulation of the right femoral artery and vein, as well as the right internal jugular vein. This access is essential for navigating the vascular system to reach the heart.
• Crossing the VSD A wire is advanced into the left pulmonary artery using a retrograde arterial approach. A catheter is then threaded over this wire, which is subsequently exchanged for a longer guidewire. The guidewire is snared in the pulmonary artery and extruded through the right internal jugular vein, creating an arteriovenous guidewire loop.
• Measuring the Septal Defect To determine the size of the septal defect, a pre-calibrated balloon catheter filled with dilute contrast is passed into the ventricle over the guidewire via the internal jugular access. The balloon is inflated, and the volume necessary for occlusion of the septal defect is measured.
• Loading the Implant Device The implant device, such as the Amplatzer septal occluder, is loaded onto a delivery catheter. This catheter is then introduced into the ventricle, where the distal disc of the device is extruded and pulled back against the distal side of the septum.
• Deploying the Device After confirming proper alignment with the septal defect, the proximal disc of the device is deployed on the opposite side of the ventricular septum and released, effectively closing the defect.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications related to the closure, such as arrhythmias or bleeding. Patients may require follow-up imaging studies to assess the position and function of the implant device. Recovery typically includes observation in a hospital setting, with the duration depending on the patient's overall condition and response to the procedure. Additional considerations may include managing any underlying heart conditions and ensuring appropriate follow-up care with a cardiologist.