CPT® Code 33478

The procedure described by CPT® Code 33478 involves outflow tract augmentation of the right ventricle, utilizing a gusset or patch. This surgical intervention is primarily aimed at addressing infundibular pulmonary stenosis, a condition characterized by an obstruction that impedes the flow of blood from the right ventricle to the pulmonary artery. The obstruction can arise from various anatomical anomalies, such as a fibrous muscle band located at the junction of the right ventricle and the infundibulum, or from a hypertrophied infundibulum that narrows the outflow tract. The surgical approach typically requires a median sternotomy to gain access to the heart, followed by the establishment of cardiopulmonary bypass to maintain circulation during the procedure. The pericardium is incised, and a patch of pericardium may be harvested for use as a graft. The right ventricular outflow tract is then incised, allowing for the excision of any obstructive fibrous tissue or the removal of excess muscular tissue to facilitate enlargement of the outflow tract. The augmentation is achieved through the application of either an autologous pericardial patch graft or a synthetic patch. Additionally, if the pulmonary valve commissures are found to be fused, the surgeon will perform a commissurotomy to restore normal function. Following the completion of the procedure, the heart is closed, and the patient is gradually weaned off cardiopulmonary bypass, with chest tubes placed as necessary to manage any postoperative drainage.