CPT® Code 33782

Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure); without coronary ostium reimplantation

The Nikaidoh procedure, designated by CPT® Code 33782, is a specialized surgical intervention aimed at correcting a complex cardiac anomaly characterized by the presence of transposition of the great arteries (TGA), a ventricular septal defect (VSD), and pulmonary stenosis (PS). This procedure is particularly significant in pediatric cardiology, as it addresses critical congenital heart defects that can severely impact the hemodynamics of the heart and overall circulation. The surgery involves a median sternotomy, which is a surgical incision made along the sternum to provide access to the heart and great vessels. During the operation, a patch graft is harvested from the pericardium, the fibrous sac surrounding the heart, to aid in the reconstruction of the heart's outflow tracts. The procedure is performed under cardiopulmonary bypass, which is achieved through bicaval cannulation, allowing for the safe manipulation of the heart while maintaining blood circulation and oxygenation. Cardioplegia, a technique used to induce temporary cardiac arrest, is initiated to facilitate the surgical steps. The surgical team mobilizes the proximal coronary arteries and incises the right ventricle, separating the aortic root from the right ventricle. The pulmonary artery is then transected, and the infundibular septum is divided to allow for the necessary anatomical rearrangements. The posterior aspect of the aortic root is sutured to the pulmonary valve annulus, while the anterior aspect is sutured over the ventricular septal defect, effectively closing the defect and redirecting blood flow. The ascending aorta is transected, a small section is removed, and the aorta is reconfigured to prevent bowing, which can lead to complications. A LeCompte maneuver is performed to reposition the ascending aorta behind the pulmonary artery, ensuring optimal alignment and function. Finally, the transected ends of the ascending aorta are sutured together, and a pericardial patch graft is utilized to reconstruct the right ventricular outflow tract, enlarging the hypoplastic main pulmonary artery to improve blood flow. This intricate procedure is critical for restoring normal hemodynamics in patients with these complex congenital heart defects.