CPT® Code 33468

1. Indications

The procedure is indicated for patients diagnosed with Ebstein anomaly, which is characterized by specific abnormalities of the tricuspid valve. The following conditions warrant the performance of this surgical intervention:

• Ebstein Anomaly A congenital heart defect involving the tricuspid valve, leading to its improper function and potential complications such as right atrial enlargement and congestive heart failure.

2. Procedure

The surgical procedure for tricuspid valve repositioning and plication involves several critical steps to ensure effective correction of the valve abnormalities associated with Ebstein anomaly:

• Step 1: Opening the Right Atrium The procedure begins with an incision to open the right atrium parallel to the atrioventricular groove, providing access to the tricuspid valve.
• Step 2: Detaching the Anterior Leaflet Starting near the anteroseptal commissure, the anterior leaflet of the tricuspid valve is carefully detached from the tricuspid annulus while maintaining its anterior attachment at the level of the commissure.
• Step 3: Detaching the Posterior Leaflet The detachment of the posterior leaflet is performed in a contiguous manner alongside the anterior leaflet until the posterior leaflet is completely freed from its attachments.
• Step 4: Cutting Fibrous Bands Any fibrous bands connecting the leaflets to the ventricular wall are cut, and the papillary muscle attachments to the ventricular wall are dissected to facilitate further manipulation of the valve.
• Step 5: Plicating the Right Ventricle Longitudinal plication of the atrialized right ventricle is then executed. A line of sutures is placed from the apex of the atrialized portion of the right ventricle to the coronary sinus, incorporating the septal leaflet attachment while leaving the septal leaflet or its remnants untouched.
• Step 6: Additional Sutures A second line of sutures is placed in the opposite direction toward the apex of the ventricle, running along the diaphragmatic endocardial surface of the atrialized chamber and including the original attachments of the posterior leaflet.
• Step 7: Repositioning the Leaflets Finally, the anterior and posterior leaflets are repositioned onto the newly created tricuspid annulus, completing the surgical correction of the valve.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications related to the surgery, such as bleeding or infection. Patients may require supportive care in an intensive care unit (ICU) setting initially, followed by gradual recovery in a regular hospital ward. The expected recovery period can vary based on the individual patient's condition and response to surgery. Follow-up appointments will be necessary to assess the function of the tricuspid valve and the overall cardiac status, ensuring that the surgical intervention has achieved the desired outcomes.