CPT® Code 33786

Truncus arteriosus is a congenital heart defect that presents as a single large vessel, known as the truncus, which arises from the heart and is responsible for supplying blood to both the systemic and pulmonary circulations. This condition is characterized by the presence of a ventricular septal defect (VSD), which is a hole between the heart's ventricles, and a single heart valve that serves both the aorta and pulmonary arteries. The Rastelli type operation is a surgical procedure designed to correct this anomaly by reconstructing the heart's anatomy to ensure proper blood flow. The surgery typically involves accessing the heart through a median sternotomy or thoracotomy, which allows the surgeon to reach the heart effectively. During the procedure, the thymus gland is removed, and a section of the pericardium, the membrane surrounding the heart, is excised for use as a patch graft later in the operation. The surgical team meticulously dissects the truncus and its branches from surrounding tissues to prepare for the reconstruction. Cardiopulmonary bypass is initiated to maintain circulation while the heart is operated on, and the aorta is cross-clamped to control blood flow. The right ventricle is opened to visualize the VSD, and any obstructive muscle tissue is removed. The closure of the pulmonary artery orifice is performed from within the heart, and an intra-ventricular baffle is created using the harvested pericardium or synthetic material to redirect blood flow appropriately. The procedure also establishes continuity between the right ventricle and pulmonary artery using either a valved homograft conduit or a synthetic graft, ensuring that blood can flow efficiently to the lungs. The operation concludes with careful suturing of the grafts and potential placement of chest tubes, with the sternum being closed or left open for future closure, depending on the patient's condition.