CPT® Code 33692

The procedure described by CPT® Code 33692 involves the complete surgical repair of tetralogy of Fallot (TOF) in neonates, specifically when pulmonary atresia is not present. Tetralogy of Fallot is a complex congenital heart defect characterized by four specific abnormalities: pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect (VSD), and overriding aorta. Pulmonary stenosis refers to the narrowing of the pulmonary valve and the outflow tract, which obstructs blood flow from the right ventricle to the pulmonary artery. This obstruction leads to increased pressure in the right ventricle, resulting in right ventricular hypertrophy, which is the thickening of the muscular walls of the right ventricle. The VSD is a defect that consists of one or more holes in the ventricular septum, allowing for abnormal blood flow between the heart's ventricles. The overriding aorta is a condition where the aorta is positioned directly above the VSD, receiving blood from both the right and left ventricles, which can lead to mixing of oxygenated and deoxygenated blood. During the surgical procedure, the heart is accessed through a median sternotomy, and cardiopulmonary bypass is established to maintain circulation while the heart is stopped using cardioplegic arrest. The VSD is repaired using a synthetic patch, which effectively closes the defect and prevents the mixing of blood. The pulmonary valve is addressed by resecting obstructive tissue to alleviate the stenosis, and if necessary, a transannular patch may be placed to enlarge the outflow tract. In cases where pulmonary atresia is present, a conduit is created from the right ventricle to the pulmonary artery to ensure proper blood flow to the lungs. This comprehensive approach aims to correct the anatomical defects associated with TOF, allowing for improved oxygenation and overall cardiac function in the neonate.