CPT® Code 33420

1. Indications

Mitral valvotomy is indicated for patients suffering from mitral stenosis, which can lead to significant cardiovascular complications. The following conditions and symptoms may warrant the performance of this procedure:

• Mitral Stenosis - A narrowing of the mitral valve orifice that obstructs blood flow from the left atrium to the left ventricle.
• Rheumatic Heart Disease - A common cause of mitral stenosis resulting from rheumatic fever.
• Calcification of the Mitral Annulus - Age-related or pathological calcification that contributes to valve narrowing.
• Infective Endocarditis - Infection of the heart valves that can lead to structural changes and stenosis.
• Systemic Lupus Erythematosus - An autoimmune condition that may affect the heart valves.
• Rheumatoid Arthritis - Another autoimmune disorder that can lead to valvular heart disease.
• Carcinoid Heart Disease - A condition associated with neuroendocrine tumors that can cause valvular dysfunction.

2. Procedure

The procedure for closed heart mitral valvotomy (CPT® 33420) involves several critical steps to ensure effective treatment of mitral stenosis:

• Step 1: Accessing the Heart - The procedure begins with a right anterolateral thoracotomy, which is performed at the fifth intercostal space. This incision allows the surgeon to gain access to the thoracic cavity and expose the heart.
• Step 2: Incising the Pericardium - Once the heart is exposed, the pericardium is incised anterior to the phrenic nerve, situated between the superior and inferior vena cava. This step is crucial for providing adequate visualization of the heart structures.
• Step 3: Retracting the Pericardium - The pericardium is then retracted to enhance visibility of the right atrium, left atrium, and pulmonary veins, which are essential for the subsequent steps of the procedure.
• Step 4: Making the Interatrial Incision - A small incision is created at the interatrial groove, specifically at the level of the pulmonary veins. This incision is vital for accessing the left atrium.
• Step 5: Placing the Purse-String Suture - A purse-string suture is placed in the fatty tissue surrounding the interatrial incision. This suture will be used to close the incision after the procedure.
• Step 6: Dilating the Mitral Valve - The interatrial incision is extended into the left atrium, and the surgeon inserts their index finger to palpate the mitral valve. The stenosis is then dilated by separating the valve leaflets with the index finger, effectively relieving the obstruction.
• Step 7: Closing the Incision - After the dilation of the mitral valve is completed, the index finger is removed, and the purse-string suture is tied to close the interatrial incision securely.

3. Post-Procedure

Post-procedure care following a closed heart mitral valvotomy involves monitoring the patient for any complications and ensuring proper recovery. Patients may require observation in a recovery unit to assess their cardiovascular status and manage any potential postoperative issues. The expected recovery period can vary based on individual patient factors, but generally, patients are advised to follow up with their healthcare provider for ongoing assessment of heart function and any necessary lifestyle modifications. Additionally, the surgical site will need to be monitored for signs of infection or other complications.