CPT® Code 33926

The procedure described by CPT® Code 33926 involves the surgical repair of pulmonary artery arborization anomalies through a technique known as unifocalization, which is performed with the assistance of cardiopulmonary bypass. Arborization anomalies are often associated with congenital heart defects, particularly pulmonary atresia and ventricular septal defects (VSD). These anomalies manifest as collateral arteries, commonly referred to as major aorto-pulmonary collateral arteries (MAPCAs), which serve as alternative pathways connecting the aorta to the pulmonary arteries in the lungs. The primary goal of the unifocalization procedure is to reconfigure these collateral arteries into a more centralized confluence, thereby improving blood flow to the lungs and enhancing oxygenation. The surgical approach typically involves either a median sternotomy or a thoracotomy, allowing access to the heart. If the procedure necessitates cardiopulmonary bypass, the aorta and both the superior and inferior vena cava are cannulated to facilitate this process. Once cardiopulmonary bypass is established, the aorta is cross-clamped to control blood flow. The surgeon then meticulously dissects the collateral arteries free from surrounding tissues and mobilizes them at their origins, which may be located in the aorta or the brachiocephalic branches. The procedure requires careful management of the pulmonary artery branches and collateral vessels, which are clamped to maintain control during the operation. Following the division of the collateral arteries from the aorta, the aortic ends are oversewn, and the distal ends of the collaterals are subsequently anastomosed to the pulmonary artery. After ensuring hemostasis at the anastomosis sites, the patient is weaned off cardiopulmonary bypass if it was utilized. The procedure concludes with the placement of chest tubes and closure of the chest incision, marking a critical step in the staged repair of complex congenital heart defects.