CPT® Code 33476

The procedure described by CPT® Code 33476 involves a surgical intervention known as right ventricular resection, specifically targeting infundibular pulmonary stenosis. This condition is characterized by an obstruction that occurs at the outflow tract of the right ventricle, which can significantly impede blood flow from the heart to the lungs. The obstruction may arise from a fibrous muscle band located at the junction where the main cavity of the right ventricle meets the infundibulum, effectively dividing the right ventricle into two distinct cavities. Alternatively, the obstruction can be caused by a hypertrophied infundibulum, which is a thickening of the muscular wall that narrows the outlet of the right ventricle. To perform this procedure, the surgeon typically begins by exposing the heart through a median sternotomy, which involves making an incision along the sternum to gain access to the thoracic cavity. Once the heart is accessible, cardiopulmonary bypass is established to take over the function of the heart and lungs during the surgery, allowing for a bloodless field and enabling the surgeon to operate safely. The right ventricle is then incised to access the area of obstruction. The surgical approach may involve excising the obstructive fibrous muscle band to alleviate the blockage or removing tissue from the thickened muscular infundibulum to enlarge the outflow tract, thereby improving blood flow. Additionally, the pulmonary valve is carefully inspected during the procedure. If the commissures of the valve are found to be fused, the surgeon will perform a commissurotomy, which involves using sharp dissection to open the three commissures of the valve. This step is crucial for ensuring proper function of the valve post-surgery. After the necessary corrections are made, the heart is closed, and the patient is gradually weaned off cardiopulmonary bypass. Finally, chest tubes may be placed as needed to facilitate drainage, and the chest is closed to complete the procedure.