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CPT®
33472

CPT® Code 33472
Deleted

Official Description

Valvotomy, pulmonary valve, open heart; with inflow occlusion

© 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, situated between the right ventricle and the pulmonary artery, plays a crucial role in regulating blood flow from the heart to the lungs. In cases of pulmonary atresia, a congenital heart defect, the pulmonary valve may be underdeveloped or completely absent, which obstructs blood flow from the right ventricle. Conversely, pulmonary stenosis involves a narrowing of the valve opening, which can also impede blood flow. The surgical approach for this procedure typically involves a median sternotomy, where an incision is made along the sternum to access the heart. During the operation, the thymus gland may be partially removed to enhance visibility and access to the heart structures. The specific procedure described by CPT® Code 33472 involves the use of inflow occlusion, where tapes are strategically placed around the superior and inferior vena cava, followed by the application of rubber tourniquets to temporarily halt blood inflow. This technique allows the surgeon to perform the valvotomy with a clear surgical field, ensuring that the pulmonary valve can be effectively inspected and treated. The procedure is critical for restoring normal blood flow and improving the patient's overall cardiac function.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Pulmonary valvotomy is indicated for the following conditions:

  • Pulmonary Atresia - A congenital heart defect where the pulmonary valve is either absent or malformed, preventing blood flow from the right ventricle to the lungs.
  • Pulmonary Stenosis - A condition characterized by the narrowing of the pulmonary valve orifice, which restricts blood flow from the heart to the pulmonary artery.

2. Procedure

The procedure for pulmonary valvotomy with inflow occlusion involves several critical steps:

  • Step 1: Median Sternotomy - The surgeon begins by making a median sternotomy incision to access the heart. This approach provides a direct pathway to the thoracic cavity and allows for optimal exposure of the heart structures.
  • Step 2: Thymus Resection - To enhance visibility and access to the heart, a partial resection of the thymus gland may be performed. This step is essential for ensuring that the surgical team can adequately visualize the pulmonary valve and surrounding anatomy.
  • Step 3: Inflow Occlusion Setup - Tapes are placed around the superior and inferior vena cava, followed by the application of rubber tourniquets. This setup is crucial for occluding blood flow to the heart, allowing the surgeon to operate in a bloodless field during the valvotomy.
  • Step 4: Incision of the Main Pulmonary Artery - Once inflow occlusion is established, the surgeon incises the main pulmonary artery above the level of the pulmonary valve. This incision provides access to the valve for inspection and intervention.
  • Step 5: Valve Inspection and Commissurotomy - The pulmonary valve is carefully inspected. If the valve annulus is deemed adequate, the surgeon proceeds to open the three commissures using sharp dissection techniques. This step is critical for alleviating the obstruction caused by stenosis.
  • Step 6: Transventricular Approach (if necessary) - If the valve annulus is not sufficiently large for a valvotomy via the main pulmonary artery, the incision is extended, and the right ventricle is opened. This transventricular approach allows for direct access to the valve for repair.
  • Step 7: Closure of Incisions - After the commissures are opened and the valve orifice is adequately enlarged, the incisions made in the right ventricle and main pulmonary artery are closed. This step is essential for restoring the integrity of the heart structures.
  • Step 8: Discontinuation of Inflow Occlusion - The inflow occlusion or cardiopulmonary bypass is then discontinued, allowing blood flow to resume through the heart.
  • Step 9: Chest Closure - Finally, chest tubes may be placed as needed to facilitate drainage, and the chest is closed securely to complete the procedure.

3. Post-Procedure

Post-procedure care following a pulmonary valvotomy with inflow occlusion includes monitoring the patient for any signs of complications, such as bleeding or infection. Patients may require chest tubes to drain any excess fluid or blood from the thoracic cavity. Recovery typically involves close observation in a hospital setting, where vital signs and cardiac function are continuously assessed. The length of hospital stay may vary based on the patient's overall health and response to the surgery. Follow-up appointments are essential to evaluate the success of the procedure and to monitor for any potential long-term effects on heart function.
Short Descr REVISION OF PULMONARY VALVE
Medium Descr VALVOTOMY PULM VALVE OPEN HRT W/INFLOW OCCLUSION
Long Descr Valvotomy, pulmonary valve, open heart; with inflow occlusion
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 9 - 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
Date
Action
Notes
2015-01-01 Deleted Code deleted
Pre-1990 Added Code added.
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