CPT® Code 33697

Complete repair tetralogy of Fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect

The procedure described by CPT® Code 33697 involves a complete surgical repair of tetralogy of Fallot (TOF) in neonates, specifically when accompanied by pulmonary atresia. Tetralogy of Fallot is a complex congenital heart defect characterized by four primary abnormalities: pulmonary stenosis, which is a narrowing that obstructs blood flow from the right ventricle to the pulmonary artery; right ventricular hypertrophy, which is the thickening of the right ventricular walls due to increased pressure; ventricular septal defect (VSD), which is a hole in the wall separating the heart's lower chambers; and overriding aorta, where the aorta is positioned directly over the VSD, allowing unoxygenated blood to mix with oxygenated blood. In cases where pulmonary atresia is present, there is a complete blockage of blood flow from the right ventricle to the pulmonary artery, necessitating the construction of a conduit to facilitate blood flow. The surgical approach typically involves a median sternotomy to access the heart, followed by the establishment of cardiopulmonary bypass and cardioplegic arrest to protect the heart during the procedure. The VSD is repaired using a synthetic patch, and the pulmonary valve is addressed by resecting obstructive tissue, potentially utilizing a transannular patch to enlarge the outflow tract. The construction of a conduit from the right ventricle to the pulmonary artery is critical in cases of pulmonary atresia, ensuring that blood can flow to the lungs for oxygenation. This comprehensive repair aims to correct the anatomical defects and restore normal blood flow, significantly improving the neonate's prognosis.