CPT® Code 33920

1. Indications

The procedure is indicated for patients diagnosed with:

• Pulmonary Atresia - A congenital heart defect characterized by the improper development of the pulmonary valve, which obstructs blood flow from the right ventricle to the pulmonary artery.
• Ventricular Septal Defect (VSD) - An opening in the septum between the right and left ventricles that can lead to abnormal blood flow and increased pressure in the heart.

2. Procedure

The surgical procedure involves several critical steps to ensure the successful repair of pulmonary atresia with VSD:

• Step 1: Exposure of the Heart - The procedure begins with a median sternotomy, which involves making an incision along the sternum to gain access to the heart. The pericardium, the protective sac surrounding the heart, is then incised, and a patch of pericardium is harvested for later use as a patch graft.
• Step 2: Establishing Cardiopulmonary Bypass - Cardiopulmonary bypass is initiated to take over the function of the heart and lungs during the surgery, allowing the surgeon to operate on a still and bloodless field.
• Step 3: Evaluation of the Pulmonary Anatomy - The main pulmonary artery and its branches, along with the external anatomy of the heart, are carefully evaluated to identify the optimal location for the conduit that will be constructed or replaced.
• Step 4: Dissection of the Pulmonary Arteries - The main pulmonary artery is dissected free from surrounding tissues, followed by the dissection of the right and left pulmonary arteries. Rubber loops are placed around these vessels to gently occlude them, controlling blood flow during the procedure.
• Step 5: Construction of the Conduit - A longitudinal incision is made in the main pulmonary artery. A conduit is then constructed using autologous pericardium, an allograft (homograft), xenograft, or synthetic material. This conduit is sutured to the arteriotomy site in the main pulmonary artery.
• Step 6: Insertion of the Conduit - The incision is extended into the right ventricle, and the conduit is inserted into the right ventricle, where it is secured with sutures. Depending on the patient's unique anatomy, the conduit may alternatively be attached to the left ventricle.
• Step 7: VSD Repair (if applicable) - If the VSD is repaired during the same surgical session, it is reported separately, ensuring that all aspects of the patient's condition are addressed.
• Step 8: Weaning Off Cardiopulmonary Bypass - After the repairs are completed, the patient is gradually weaned off cardiopulmonary bypass. Chest tubes are placed as needed to drain any excess fluid or blood, and the chest incision is then closed.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring proper recovery. Patients may require intensive care following the surgery to manage their recovery effectively. The placement of chest tubes is common to facilitate drainage and prevent fluid accumulation. The healthcare team will monitor vital signs, cardiac function, and overall recovery progress. Follow-up appointments will be necessary to assess the success of the repair and to plan any further interventions if needed.