CPT® Code 33688

1. Indications

The closure of a single ventricular septal defect (VSD) as described in CPT® Code 33688 is indicated for patients presenting with the following conditions:

• Ventricular Septal Defect (VSD) - A congenital anomaly characterized by an opening in the septum between the ventricles, which can lead to increased pulmonary blood flow and potential heart failure.
• Pulmonary Overcirculation - A condition where excessive blood flow to the lungs occurs, often necessitating surgical intervention to prevent complications such as pulmonary hypertension.
• Pulmonary Artery Hypertension - Elevated blood pressure in the pulmonary artery that may arise from untreated VSD, requiring closure to alleviate the condition.
• Obstruction of Right Ventricular Outflow - Situations where the VSD is associated with obstruction, such as in cases of Tetralogy of Fallot, may also warrant this procedure.

2. Procedure

The procedure for the closure of a single ventricular septal defect (VSD) involves several critical steps:

• Step 1: Incision and Access - The surgeon begins by making an incision in the chest to access the heart. This is typically done through a thoracotomy, allowing for direct visualization and manipulation of the heart structures.
• Step 2: Pericardial Incision - Once access is achieved, the pericardium, which is the fibrous sac surrounding the heart, is incised to expose the heart for the surgical repair.
• Step 3: Initiation of Cardiopulmonary Bypass - Cardiopulmonary bypass is initiated to take over the function of the heart and lungs during the procedure, ensuring that blood circulation and oxygenation are maintained while the heart is being operated on.
• Step 4: VSD Repair - The ventricular septal defect is then repaired. This may involve suturing the edges of the defect together or placing a patch over the opening. The patch can be made from synthetic material or harvested from the patient's own pericardium, depending on the specific circumstances of the case.
• Step 5: Removal of Pulmonary Artery Band - If a pulmonary artery band has been previously placed, it is carefully dissected free and removed during this procedure. This band is typically used as a temporary measure to control pulmonary overcirculation.
• Step 6: Evaluation of Pulmonary Artery Pressures - After the VSD is repaired, the surgeon evaluates the pulmonary artery pressures using a pressure transducer probe. If the pressures are found to be elevated, further intervention may be required.
• Step 7: Placement of Gusset (if necessary) - If the pulmonary artery pressures are too high, the surgeon may incise the narrowed area and place a gusset, which is a patch designed to increase the diameter of the pulmonary artery, thereby improving blood flow.
• Step 8: Closure of Incisions - Finally, the access incision is closed, and chest tubes are placed to facilitate drainage. The chest incision is then sutured closed, completing the procedure.

3. Post-Procedure

Post-procedure care following the closure of a single ventricular septal defect includes monitoring the patient for any complications, such as bleeding or infection. Patients are typically observed in a recovery area 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. The expected recovery period may vary depending on the individual patient's condition and the complexity of the surgery performed. Follow-up appointments are essential to assess the success of the repair and to monitor for any potential long-term complications related to the VSD or the surgical intervention.