CPT® Code 33505

Repair of anomalous coronary artery from pulmonary artery origin; with construction of intrapulmonary artery tunnel (Takeuchi procedure)

The procedure described by CPT® Code 33505 involves the surgical repair of an anomalous coronary artery that originates from the pulmonary artery. This condition can lead to significant cardiac complications, as the anomalous artery may not supply adequate blood flow to the heart muscle. The surgical intervention, known as the Takeuchi procedure, aims to correct this anomaly by constructing an intrapulmonary artery tunnel. During the operation, the physician gains access to the heart through a median sternotomy, which involves making an incision along the sternum to open the chest cavity. The procedure can be performed using cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs, or it can be done on a beating heart using an off-pump technique, allowing for a more direct approach without the need for bypass. The pericardium, the protective sac surrounding the heart, is incised, and a section is harvested to create the tunnel necessary for the repair. An aortopulmonary window is then created in the walls of both the aorta and the pulmonary artery, facilitating the construction of the tunnel. This tunnel is fashioned from the harvested pericardial tissue and is attached to the origin of the anomalous coronary artery within the pulmonary artery. It is then passed through the pulmonary artery to the aortopulmonary window and secured to the aorta, effectively rerouting blood flow. After the completion of the procedure, if cardiopulmonary bypass was utilized, it is discontinued, and chest tubes may be placed as needed before closing the chest. This complex surgical intervention is critical for restoring normal coronary circulation and preventing potential cardiac complications associated with the anomalous artery.