CPT® Code 33474

1. Indications

The pulmonary valvotomy procedure is indicated for specific congenital heart conditions that impede normal blood flow from the right ventricle to the pulmonary artery. The following conditions warrant this surgical intervention:

• Pulmonary Atresia - A congenital defect where the pulmonary valve is either absent or does not open properly, preventing blood from flowing to the lungs.
• Pulmonary Stenosis - A condition characterized by the narrowing of the pulmonary valve orifice, which restricts blood flow and can lead to increased pressure in the right ventricle.

2. Procedure

The procedure for pulmonary valvotomy involves several critical steps to ensure effective treatment of the identified conditions. The following outlines the procedural steps:

• Step 1: Accessing the Heart - The surgery begins with a median sternotomy, where the chest is opened to provide direct access to the heart. In some cases, the thymus gland may be partially resected to enhance visibility and access to the cardiac structures.
• Step 2: Initiating Cardiopulmonary Bypass - The patient is placed on cardiopulmonary bypass, which takes over the function of the heart and lungs during the procedure. This is achieved by cannulating the ascending aorta and the right atrial appendage, allowing for the circulation of blood while the heart is temporarily stopped.
• Step 3: Exposing the Pulmonary Valve - The main pulmonary artery is incised above the level of the pulmonary valve to allow for direct inspection of the valve. This step is crucial for assessing the condition of the valve annulus.
• Step 4: Performing the Valvotomy - If the valve annulus is deemed adequate, the surgeon proceeds to open the three commissures of the valve using sharp dissection. If the annulus is too small for this approach, the incision is extended, and the right ventricle is opened to facilitate a transventricular approach for repair.
• Step 5: Closing the Incisions - After successfully opening the valve orifice, the incisions made in the right ventricle and the main pulmonary artery are carefully closed. This step is essential to restore the integrity of the heart structures.
• Step 6: Concluding the Procedure - Once the repairs are completed, cardiopulmonary bypass is discontinued, and the heart is allowed to resume its normal function. Chest tubes may be placed as needed to drain any excess fluid, and the chest is subsequently closed to complete the procedure.

3. Post-Procedure

After the pulmonary valvotomy, patients typically require close monitoring in a postoperative setting to assess their recovery. Expected post-procedure care includes managing pain, monitoring vital signs, and ensuring proper drainage from any chest tubes placed during surgery. The recovery period may vary depending on the individual patient's condition and response to surgery. Follow-up appointments are essential to evaluate the success of the procedure and to monitor for any potential complications. Patients may also need to adhere to specific activity restrictions during their recovery to promote healing and prevent strain on the heart.