CPT® Code 33665

1. Indications

The procedure described by CPT® Code 33665 is indicated for patients with an intermediate or transitional atrioventricular canal defect, which may present with various symptoms and conditions. The following are the explicitly provided indications for performing this surgical repair:

• Atrioventricular Septal Defect (AVSD) - This condition is characterized by a defect in the atrioventricular septum, leading to abnormal blood flow between the heart's chambers.
• Heart Failure Symptoms - Patients may exhibit signs of heart failure due to the inefficient pumping of blood caused by the defect.
• Increased Pulmonary Blood Flow - The defect can lead to excessive blood flow to the lungs, resulting in pulmonary congestion and related complications.
• Growth and Development Concerns - Children with AVSD may experience growth delays or failure to thrive due to compromised cardiac function.

2. Procedure

The surgical procedure for CPT® Code 33665 involves several critical steps to effectively repair the atrioventricular canal defect. Each step is essential for ensuring the successful outcome of the surgery:

• Step 1: Accessing the Heart - The procedure begins with a median sternotomy, which involves making an incision along the sternum to gain access to the heart. This approach allows the surgeon to visualize and operate on the heart structures directly.
• Step 2: Establishing Cardiopulmonary Bypass - After accessing the heart, bicaval and aortic cannulas are inserted to establish cardiopulmonary bypass. This technique temporarily takes over the function of the heart and lungs, allowing the surgeon to operate on a still heart.
• Step 3: Incising the Pericardium - The pericardium, the protective sac surrounding the heart, is incised to expose the heart for surgical intervention. A patch is harvested from the pericardium for use in repairing the septal defects.
• Step 4: Atriotomy and Exposure of the AVSD - The right atrium is incised (atriotomy) to expose the atrioventricular septal defect. This step is crucial for accessing the defect and evaluating the surrounding structures.
• Step 5: Valve Inspection and Repair - The tricuspid and mitral valves are inspected for size and competence. The cleft in the mitral valve is repaired first, followed by any necessary repairs to the tricuspid valve to ensure proper function.
• Step 6: Closing the Atrial Septal Defect - The atrial septal defect (ASD) is closed using a patch of pericardium or sutures, depending on the size of the defect.
• Step 7: Closing the Ventricular Septal Defect - The small ventricular septal defect (VSD) is closed with sutures, and the cleft in the atrioventricular valve is repaired to form two separate valves.
• Step 8: Final Valve Assessment - The common atrioventricular valve is elevated, and its competence and structure are evaluated. If separation of the valve is possible, it is performed; otherwise, prosthetic valves may be considered.
• Step 9: Closing the Procedure - After all repairs are completed, the right atrial incision is closed, and the patient is weaned off cardiopulmonary bypass. Chest tubes are placed as needed, and the chest incision is closed.

3. Post-Procedure

Following the surgical repair of the atrioventricular canal defect, patients typically require careful monitoring and post-operative care. Expected recovery includes observation for any complications such as bleeding, infection, or arrhythmias. Patients may need to stay in the hospital for several days to ensure stable recovery and to monitor heart function. Pain management and gradual mobilization are important aspects of post-operative care. Additionally, follow-up appointments will be necessary to assess the success of the repair and the function of the heart valves. Long-term follow-up may also be required to monitor for any late complications or the need for further interventions.