CPT® Code 33778

The procedure described by CPT® Code 33778 involves the surgical repair of transposition of the great arteries, specifically through a technique known as aortic and pulmonary artery reconstruction, commonly referred to as the Jatene procedure. Transposition of the great arteries is a congenital heart defect characterized by the abnormal positioning of the aorta and pulmonary arteries. In a normal heart, the aorta arises from the left ventricle, while the pulmonary arteries originate from the right ventricle. However, in this condition, the aorta is connected to the right ventricle, and the pulmonary arteries are connected to the left ventricle. This anatomical misconfiguration results in a situation where oxygen-poor blood is circulated back to the body without passing through the lungs for oxygenation, while oxygen-rich blood is returned to the lungs instead of being delivered to the body. This condition is often associated with other cardiac anomalies, such as ventricular septal defect (VSD) and subpulmonary stenosis. VSD is defined as an abnormal opening in the ventricular septum, which allows for the mixing of oxygen-rich and oxygen-poor blood. Subpulmonary stenosis refers to a narrowing of the main pulmonary artery just below the pulmonary valve, which can further complicate the condition. The surgical approach to repair this anomaly typically involves accessing the heart through a median sternotomy or thoracotomy, during which the thymus gland may be resected to provide better access. The pericardium is incised, and a section is harvested for use as a patch graft later in the procedure. The surgical team dissects the ascending aorta and the main pulmonary artery, along with its branches, free from surrounding tissues. Cannulation of the aorta and the superior and inferior vena cava is performed to establish cardiopulmonary bypass, allowing the heart to be temporarily stopped and blood to be diverted. The aorta is cross-clamped, and both the ascending aorta and the main pulmonary artery are transected. The coronary artery ostia at the anomalous aortic root are visualized and excised, and these ostia are then transferred to the newly created aortic root in the left ventricle. The distal main pulmonary artery and its branches are repositioned to connect with the right ventricle, while the aorta is relocated posteriorly to the left ventricle. The distal aorta is then anastomosed to the newly formed aortic root, and the coronary arteries are also anastomosed to the new aortic outflow tract. This complex procedure aims to restore normal blood flow and improve oxygenation in patients with transposition of the great arteries.