CPT® Code 33647

The procedure described by CPT® Code 33647 involves the surgical repair of two specific congenital heart defects: the atrial septal defect (ASD) and the ventricular septal defect (VSD). An ASD is characterized by an abnormal opening in the interatrial septum, which is the wall separating the right and left atria, the upper chambers of the heart. This defect allows for the mixing of oxygenated blood from the left atrium with unoxygenated blood from the right atrium, potentially leading to various complications, including heart failure and pulmonary hypertension. Similarly, a VSD is defined as an abnormal opening in the interventricular septum, the wall separating the right and left ventricles, the lower chambers of the heart. This defect permits the mixing of oxygenated blood from the left ventricle with unoxygenated blood from the right ventricle, which can also result in significant clinical issues if left untreated. The surgical approach to repair these defects typically involves accessing the heart through a median sternotomy, which entails making an incision along the sternum to gain direct access to the heart. Once the heart is accessed, the pericardium, the protective sac surrounding the heart, is incised, and a graft of pericardium may be harvested if necessary for the repair. The procedure is performed under cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs, allowing the surgeon to operate on a still and bloodless field. The right atrium is opened to facilitate the closure of the ASD, which can be accomplished using sutures or by placing a patch over the defect. The patch may be made from the harvested pericardium or synthetic material, depending on the specific requirements of the repair. Following the closure of the ASD, the VSD is addressed through various possible incisions, including those in the right atrium, pulmonary artery, or the outflow tract of the right ventricle. The defect is then sutured closed or patched similarly to the ASD repair. After completing the repairs, the heart incisions are closed, and the cardiopulmonary bypass is discontinued, followed by the placement of chest tubes and closure of the chest incision. This comprehensive approach aims to restore normal blood flow and function within the heart, addressing the complications associated with these congenital defects.