Ask Dr. Z

Background: Newborn with supracadiac TAPVR and ASD had surgical repair by anastomosing common pulmonary vein confluence to the LA. Residual malaligned atrial septal tissue was resected, and ASD was closed with a patch, very carefully aligned along the ridge of the resected septal tissue. Two days later echo showed IVC draining into the LA. Surgeon explored the anatomy very carefully and determined that the IVC to LA was truly a congenital anomaly and not an iatrogenic redirection from the previous ASD patch. Second surgery: “I removed the suture line from the ASD patch, excised the lower part of the atrial septum all the way down to the IVC opening, and then excised the residual separation between the IVC and the right atrium all the way down below the level of the coronary sinus. Then, I sutured the ASD patch posteriorly onto the left atrial wall using 7-0 Prolene continuous suture. With this, the IVC was clearly now on the right side, and then I closed the right atrium with 6-0 Prolene continuous suture in two layers.” How would you code the second surgery?