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Official Description

Valvotomy, pulmonary valve, closed heart; transventricular

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Pulmonary valvotomy, also known as commissurotomy, is a surgical procedure aimed at addressing conditions such as pulmonary atresia and pulmonary stenosis. The pulmonary valve is a critical structure located between the right ventricle of the heart and the pulmonary artery, playing a vital role in regulating blood flow from the heart to the lungs. In cases of pulmonary atresia, a congenital heart defect, the pulmonary valve is either absent or malformed, preventing proper blood flow. Conversely, pulmonary stenosis refers to a narrowing of the valve orifice, which restricts blood flow and can lead to increased pressure within the heart. The procedure is typically performed through a median sternotomy, which involves making an incision along the breastbone to access the heart. During the operation, the thymus gland may be partially resected to enhance visibility and access to the heart structures. The transventricular approach utilized in CPT® Code 33470 involves placing a purse-string suture in the right ventricular wall below the pulmonary valve, allowing for a small incision to be made. This technique enables the surgeon to introduce a clamp to tear the fused commissures of the valve, followed by the use of dilators to expand the valve orifice to an adequate size, ensuring improved blood flow from the heart to the lungs.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The pulmonary valvotomy procedure is indicated for specific congenital heart conditions that impede normal blood flow from the right ventricle to the pulmonary artery. The following conditions warrant this surgical intervention:

  • Pulmonary Atresia - A congenital defect where the pulmonary valve is either absent or does not open properly, preventing blood from flowing to the lungs.
  • Pulmonary Stenosis - A condition characterized by the narrowing of the pulmonary valve orifice, which restricts blood flow and can lead to increased pressure in the right ventricle.

2. Procedure

The procedure for pulmonary valvotomy via the transventricular approach involves several critical steps to ensure successful intervention. Each step is designed to facilitate access to the pulmonary valve and effectively address the underlying condition.

  • Step 1: Preparation and Access The patient is positioned appropriately, and general anesthesia is administered. A median sternotomy is performed to gain access to the heart. The thymus gland may be partially resected to improve visibility and access to the surgical site.
  • Step 2: Purse-string Suture Placement A purse-string suture is placed in the right ventricular wall just below the pulmonary valve. This suture is crucial as it will allow for a controlled incision in the ventricle.
  • Step 3: Incision and Clamp Introduction A small incision is made in the right ventricle within the confines of the purse-string suture. A mosquito clamp is then introduced through this incision and passed through the narrowed opening of the pulmonary valve.
  • Step 4: Valve Opening The clamp is utilized to open the pulmonary valve by tearing the fused commissures, which are the points where the valve leaflets meet. This step is essential for restoring proper function to the valve.
  • Step 5: Dilation of the Valve Orifice After the clamp is removed, a series of dilators are introduced into the right ventricle and through the pulmonary valve. These dilators are used to expand the valve orifice to a sufficient diameter, ensuring adequate blood flow.
  • Step 6: Closure Once the valve has been adequately dilated, all surgical instruments are removed, and the incision in the right ventricle is closed by tightening the previously placed purse-string suture, effectively sealing the surgical site.

3. Post-Procedure

After the pulmonary valvotomy procedure, patients are typically monitored in a recovery area for any immediate complications. Post-operative care may include pain management, monitoring of vital signs, and assessment of heart function. Patients may require follow-up visits to evaluate the success of the procedure and to ensure that the pulmonary valve is functioning properly. Recovery time can vary based on individual patient factors, but most patients can expect to resume normal activities within a few weeks, contingent upon their overall health and the absence of complications.

Short Descr REVISION OF PULMONARY VALVE
Medium Descr VALVOTOMY PULMONARY VALVE CLSD HEART TRANSVENTR
Long Descr Valvotomy, pulmonary valve, closed heart; transventricular
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE Not applicable/unspecified.
CCS Clinical Classification 43 - Heart valve procedures
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2021-12-31 Deleted Code deleted
Pre-1990 Added Code added.
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