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35876 vs. 35211 vs. 39999 for Ascending Aorta Pseudoaneurysm Repair

Date: Nov 25, 2014

Question:

The pt had Bentall procedure 2mo ago with Magna valve and Valsalva graft.Now has returned due to pseudoaneurysm of the ascending aorta.CP bypass was initiated. His previous median sternotomy incision was opened.I crossclamped ascending aorta.We entered the rt coronary button and a thrombus around the graft.Thrombus was removed.There seemed to be bleeding coming up from underneath the right side coronary button,coronary sinus and rt/lt commissure area. We then performed a transverse incision thru the previously placed Dacron graft, above the sinus of Valsalva section of the graft. There was no evidence of injury of the valve.I then cut alongside the rt coronary button down thru the Valsalva segment of the graft.It was difficult to find hole where the bleeding was coming from. I then decided to reinforce the whole area with sutures. These were placed thru the prior sinus segment, LVOT, and back up thru the sewing ring of the valve and the rt coronary sinus segment. I then repaired the sinus of Valsalva graft segment with Prolene. Then graft incision was closed.

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