CPT® Code 33610

1. Indications

The procedure is indicated for patients with complex cardiac anomalies, particularly those with a single functioning ventricle and associated conditions that necessitate surgical intervention. The following are specific indications for performing the repair of complex cardiac anomalies through the enlargement of a ventricular septal defect:

• Single Ventricle Condition Patients with a single functioning ventricle, where one ventricle is underdeveloped, require surgical intervention to improve blood flow and oxygenation.
• Subaortic Obstruction The presence of subaortic obstruction in conjunction with a VSD may necessitate surgical enlargement to facilitate adequate blood mixing and systemic circulation.
• Severe Symptoms Patients exhibiting severe symptoms related to inadequate oxygenation or heart failure due to the VSD may be candidates for this surgical procedure.

2. Procedure

The surgical procedure for the repair of complex cardiac anomalies through the enlargement of a ventricular septal defect involves several critical steps, each designed to ensure effective correction of the defect and restoration of normal blood flow. The following outlines the procedural steps:

• Step 1: Median Sternotomy The procedure begins with a median sternotomy, which involves making an incision along the midline of the chest to gain access to the heart. This approach allows the surgeon to visualize and operate on the heart effectively.
• Step 2: Initiation of Cardiopulmonary Bypass Once access to the heart is achieved, cardiopulmonary bypass is initiated. This technique temporarily takes over the function of the heart and lungs, allowing for a bloodless surgical field and maintaining circulation during the procedure.
• Step 3: Incision of the Ventricle The surgeon then incises the ventricle to expose the ventricular septal defect. This step is crucial for accessing the area that requires repair.
• Step 4: Enlargement of the VSD The ventricular septal defect is enlarged by incising the interventricular septum. This enlargement is necessary to facilitate the mixing of oxygenated and unoxygenated blood, which is vital for patients with complex cardiac anomalies.
• Step 5: Closure of the Ventricle After the VSD has been adequately enlarged, the incision in the ventricle is closed. This step is essential to restore the integrity of the heart structure and ensure proper function.
• Step 6: Discontinuation of Cardiopulmonary Bypass Following the closure of the ventricle, cardiopulmonary bypass is discontinued, allowing the heart to resume its normal function.
• Step 7: Placement of Chest Tubes Chest tubes are placed to facilitate the drainage of any fluid that may accumulate in the thoracic cavity post-surgery, which is a standard practice to prevent complications.
• Step 8: Closure of the Chest Incision Finally, the chest incision is closed, completing the surgical procedure. This step ensures that the surgical site is properly sealed and promotes healing.

3. Post-Procedure

Post-procedure care is critical for ensuring a successful recovery following the surgical enlargement of the ventricular septal defect. Patients are typically monitored closely in a postoperative setting to assess their recovery and manage any potential complications. Expected recovery may include a stay in the intensive care unit (ICU) for monitoring of vital signs, cardiac function, and fluid balance. Pain management is also an essential aspect of post-operative care, as patients may experience discomfort from the surgical incision. The placement of chest tubes will be monitored to ensure proper drainage and prevent fluid accumulation. Patients will be gradually weaned off any mechanical support as their condition stabilizes. Follow-up appointments will be necessary to evaluate the surgical outcome and the overall cardiac function, ensuring that the patient is recovering as expected and that the enlargement of the VSD has effectively improved blood flow and oxygenation.