CPT® Code 33781

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with repair of subpulmonic obstruction

The procedure described by CPT® Code 33781 involves the surgical repair of transposition of the great arteries, specifically incorporating 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 emerges from the right ventricle, and the pulmonary arteries stem from the left ventricle. This anatomical misplacement results in a critical circulatory issue where oxygen-poor blood is sent back to the body without passing through the lungs for oxygenation, while oxygen-rich blood is returned to the lungs instead of being distributed to the body. This condition is often associated with other cardiac anomalies, such as ventricular septal defect (VSD) and subpulmonary stenosis. VSD is characterized by an abnormal opening in the ventricular septum, allowing 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 patient's condition. The surgical approach typically involves accessing the heart through a median sternotomy or thoracotomy, during which the thymus may be resected, and the pericardium is incised to harvest a section for use as a patch graft. The procedure requires meticulous dissection of the ascending aorta and main pulmonary artery, followed by the establishment of cardiopulmonary bypass to facilitate the surgical repair. The complex nature of this surgery necessitates careful handling of the coronary arteries and the reconstruction of the aortic and pulmonary outflow tracts to restore normal blood flow. The specific code 33781 is utilized when the baffle procedure is performed alongside the repair of subpulmonic obstruction, highlighting the comprehensive nature of this surgical intervention aimed at correcting a life-threatening congenital heart defect.