CPT® Code 33414

The procedure described by CPT® Code 33414 involves the surgical repair of a left ventricular outflow tract obstruction (LVOTO) through a technique known as patch enlargement. This condition specifically pertains to obstructions that occur in the subvalvular region of the heart, meaning that the obstruction is located below the aortic valve and does not involve the aortic valve itself or the junction between the left ventricle and the aorta. The obstruction can lead to significant complications, as it hinders the normal flow of blood from the left ventricle, resulting in increased pressure and workload on the heart. Over time, this increased workload can cause the heart muscle to thicken, a condition known as left ventricular hypertrophy, and may ultimately lead to heart failure if not addressed. To perform this procedure, the surgeon gains access to the heart through a median sternotomy, which involves making an incision along the sternum to open the chest cavity. Once access is achieved, cardiopulmonary bypass is initiated to take over the function of the heart and lungs during the surgery, allowing the surgeon to operate on a still and bloodless field. The surgical approach involves making an incision in the right ventricle to access the ventricular septum, which is the wall separating the left and right ventricles. The surgeon then incises the ventricular septum and utilizes a synthetic patch to enlarge the outflow tract of the left ventricle, effectively alleviating the obstruction. After the patch is placed, the incision in the right ventricle is closed using a pericardial patch, and once the procedure is complete, cardiopulmonary bypass is discontinued, and the chest incisions are closed. This comprehensive approach aims to restore normal blood flow from the left ventricle, thereby reducing the risk of further cardiac complications.