In code Table 02R, Replacement of Heart and Great Vessels, new seventh character qualifier values L, “In Existing Conduit and M Native Site,” have been added as noted below. The change will allow distinguishing transcatheter replacement of the pulmonary valve at a native site versus at an existing conduit site.
|H Pulmonary Valve||3 Percutaneous||8 Zooplastic Tissue||H Transapical
L In Existing Conduit
M Native Site
Z No Qualifier
Transcatheter replacement of the pulmonary valve at the valve’s native site is typically performed for Tetralogy of Fallot with either pulmonary valve stenosis or pulmonary atresia. Less commonly, it may be performed for truncus arteriosus, double-outlet right ventricle, and other congenital conditions, which affect blood flow to the lungs. The procedure typically uses zooplastic valve tissue mounted onto an hourglass-shaped nitinol frame for delivery, seating, and when replacing the pulmonary artery at its native site between the right ventricle and the main pulmonary artery.
Another type of transcatheter pulmonary valve replacement is performed within a previously placed right ventricular-pulmonary artery (RV-PA) valved conduit. This procedure has been performed for approximately 10 years, but it does not take place at the native site. The RV-PA conduit is designed with a bioprosthetic valve inside the conduit, which takes over the function of the pulmonary valve, albeit at a different location. As the patient grows, if the valve within the conduit develops dysfunction, the valve can be replaced by implanting another valve within the conduit via a transcatheter “valve-in-valve” technique.