CPT® Code 33677

1. Indications

The closure of multiple ventricular septal defects (VSDs) with the removal of a pulmonary artery band is indicated in patients presenting with the following conditions:

• Multiple Ventricular Septal Defects - The presence of multiple openings in the ventricular septum that require surgical intervention to prevent complications such as heart failure or pulmonary hypertension.
• Pulmonary Overcirculation - Situations where excessive blood flow to the lungs is present, necessitating the removal of a previously placed pulmonary artery band to restore normal hemodynamics.
• Congenital Heart Anomalies - Patients with congenital heart defects that include VSDs, particularly when associated with conditions like Tetralogy of Fallot, where obstruction of the right ventricular outflow tract may also be present.

2. Procedure

The surgical procedure for CPT® Code 33677 involves several critical steps to ensure the successful closure of the VSDs and the removal of the pulmonary artery band:

• Step 1: Incision and Access - The surgeon begins by making an incision in the chest to access the heart. This incision allows for direct visualization and manipulation of the cardiac structures.
• Step 2: Pericardial Incision - Following the chest incision, the pericardium, which is the fibrous sac surrounding the heart, is incised to provide further access to the heart's surface.
• Step 3: Initiation of Cardiopulmonary Bypass - Cardiopulmonary bypass is initiated to maintain blood circulation and oxygenation while the heart is temporarily stopped for surgical intervention.
• Step 4: Evaluation of the Pulmonary Artery - The pulmonary artery is exposed, and a pressure transducer probe is utilized to assess the existing pulmonary artery stenosis and pressures, which is crucial for determining the need for further intervention.
• Step 5: Removal of the Pulmonary Artery Band - The previously placed pulmonary artery band is carefully dissected free and removed. This step is essential to alleviate any obstruction and restore normal blood flow.
• Step 6: Closure of Ventricular Septal Defects - The VSDs are then repaired using sutures or patches, which may include synthetic materials or previously harvested pericardial patches, to effectively close the defects.
• Step 7: Post-Removal Evaluation - After the VSDs are closed, pulmonary artery pressures are re-evaluated. If pressures remain elevated, the surgeon may incise the narrowed area and place a gusset, which is a patch designed to increase the diameter of the pulmonary artery.
• Step 8: Closure of Incisions - The access incision is closed, and chest tubes are placed to facilitate drainage of any excess fluid. Finally, the chest incision is closed to complete the procedure.

3. Post-Procedure

Post-procedure care following the closure of multiple VSDs and removal of the pulmonary artery band includes monitoring the patient for any signs of complications, such as infection or bleeding. Patients are typically placed in a recovery area where vital signs are closely observed. The placement of chest tubes allows for the drainage of fluid and helps prevent complications such as pleural effusion. The expected recovery period may vary depending on the patient's overall health and the complexity of the surgery, but patients are generally monitored in a hospital setting for several days. Follow-up evaluations will assess the success of the VSD closure and the patient's cardiac function, ensuring that pulmonary pressures remain within normal limits and that the heart is functioning effectively.