Ask Dr. Z

I know the sternotomy and exploration are inclusive, but need guidance on the perforation repair. I have 33300 and 33268. Perforation occurred during a Watchman placement.

Emergency Sternotomy

Emergency mediastinal exploration

Repair right atrial appendage perforation

Excision left atrial appendage

Perforation on the medial aspect of the right atrial appendage was noted and grasped and controlled with DeBakey clamps. Vas clamp placed last across the site. Patient received 10,000 units of heparin intravenous.

Main portion of pericardium/mediastinum was evaluated. No obvious additional perforations. The right atrial appendage perforation was then oversewn with pledgeted 4-0 Prolene sutures. Hemostasis was achieved. The perforation appeared to be adjacent to the aorta slightly cephalad from the noncoronary cusp. The adventitia appeared to be slightly irritated; however, there was no perforation.

Left atrial appendage was ligated with a GIA stapling device.