CPT® Code 33684

1. Indications

The procedure described by CPT® Code 33684 is indicated for patients with a single ventricular septal defect (VSD) that is associated with obstruction of the right ventricular outflow tract. This condition may occur in conjunction with mild (acyanotic) tetralogy of Fallot. The indications for performing this surgical intervention include:

• Single Ventricular Septal Defect The presence of one or more abnormal openings in the septum between the ventricles that require closure to prevent complications.
• Obstruction of Right Ventricular Outflow Conditions where the VSD is accompanied by an obstruction in the outflow tract of the right ventricle, necessitating surgical intervention to improve blood flow.
• Acyanotic Tetralogy of Fallot A specific type of congenital heart defect where the VSD occurs alongside other structural heart issues, leading to compromised blood flow and potential heart failure if left untreated.

2. Procedure

The procedure for CPT® Code 33684 involves several critical steps to ensure the effective closure of the VSD and the management of any associated outflow tract obstruction. The steps are as follows:

• Accessing the Heart An incision is made in the chest to provide access to the heart. The pericardium, which is the fibrous sac surrounding the heart, is incised to allow for further surgical intervention.
• Initiating Cardiopulmonary Bypass Cardiopulmonary bypass is initiated to maintain blood circulation and oxygenation while the heart is temporarily stopped for surgery. This is a critical step that allows the surgeon to operate on a still heart.
• Repairing the Ventricular Septal Defect The surgical team identifies the single VSD and repairs it through an incision made in the right ventricle or pulmonary artery. The defect is typically repaired using sutures or, if necessary, a patch made from synthetic material or harvested pericardium.
• Addressing Outflow Tract Obstruction If there is an obstruction in the right ventricular outflow tract, the surgeon excises any obstructive fibrous or muscle bands. Alternatively, tissue may be removed from the thickened muscular infundibulum to enlarge the outflow tract, facilitating improved blood flow.
• Inspecting and Repairing the Pulmonary Valve The pulmonary valve is inspected for any abnormalities. If the commissures of the valve are fused, they are opened using sharp dissection to restore normal function.
• Closing the Incision After the VSD is repaired and any necessary adjustments to the outflow tract and pulmonary valve are made, the access incision is closed. Cardiopulmonary bypass is then discontinued, and chest tubes are placed to facilitate drainage. Finally, the chest incision is closed securely.

3. Post-Procedure

Post-procedure care following the closure of a single VSD with pulmonary valvotomy or infundibular resection involves monitoring the patient for any complications and ensuring proper recovery. Patients are typically observed in a recovery unit where vital signs are closely monitored. The presence of chest tubes allows for the drainage of any excess fluid or blood that may accumulate in the chest cavity. Pain management is also an essential aspect of post-operative care. Patients may require follow-up visits to assess the success of the procedure and monitor for any potential long-term complications, such as arrhythmias or residual defects. Rehabilitation and gradual return to normal activities are encouraged as the patient heals.