CPT® Code 33767

1. Indications

The bidirectional Glenn procedure (CPT® Code 33767) is indicated for patients experiencing cyanosis due to congenital heart defects. The following conditions may warrant this procedure:

• Tetralogy of Fallot A congenital heart defect characterized by four specific heart abnormalities that result in insufficient oxygenated blood reaching the body.
• Other Congenital Heart Anomalies Various other cardiac anomalies that lead to inadequate blood flow and oxygenation, necessitating surgical intervention to improve pulmonary circulation.

2. Procedure

The bidirectional Glenn procedure involves several critical steps to establish a shunt between the superior vena cava and the pulmonary artery:

• Step 1: Median Sternotomy The procedure begins with a median sternotomy, where the surgeon makes an incision along the sternum to access the heart and major blood vessels.
• Step 2: Establishing Cardiopulmonary Bypass Once access is obtained, cardiopulmonary bypass is initiated to maintain blood circulation and oxygenation during the surgery.
• Step 3: Ligation of Azygos and Hemiazygos Veins The azygos and hemiazygos veins are ligated to prevent blood flow through these vessels during the procedure.
• Step 4: Clamping and Transecting the Superior Vena Cava The superior vena cava is clamped and transected between the clamps to prepare for the anastomosis.
• Step 5: Suturing the Cardiac End The cardiac end of the superior vena cava is sutured in two layers to ensure proper closure and prevent leakage.
• Step 6: Incising the Right Pulmonary Artery The right pulmonary artery is incised longitudinally to facilitate the anastomosis with the superior vena cava.
• Step 7: Anastomosis of the Superior Vena Cava to the Right Pulmonary Artery The superior vena cava is then anastomosed in an end-to-side fashion to the right pulmonary artery, allowing blood flow from the superior vena cava to enter both pulmonary arteries.
• Step 8: Releasing the Clamps After the anastomosis is completed, the clamps are released, restoring blood flow through the newly created shunt.
• Step 9: Weaning Off Cardiopulmonary Bypass The patient is gradually weaned off cardiopulmonary bypass, ensuring stable hemodynamics before proceeding.
• Step 10: Chest Tube Placement and Closure Chest tubes are placed as needed to drain any excess fluid, and the chest incision is closed to complete the procedure.

3. Post-Procedure

After the bidirectional Glenn procedure, patients typically require close monitoring in a postoperative setting. Expected recovery includes observation for any complications related to the surgery, such as bleeding or infection. Patients may experience some discomfort at the incision site, which can be managed with appropriate pain relief measures. The placement of chest tubes is common to facilitate drainage and prevent fluid accumulation in the chest cavity. The duration of the hospital stay may vary based on the patient's overall condition and response to the procedure. Follow-up care is essential to assess the effectiveness of the shunt and monitor for any potential complications or need for further interventions.