CPT® Code 33710

1. Indications

The procedure described by CPT® Code 33710 is indicated for the following conditions:

• Sinus of Valsalva Fistula: This condition is often congenital but may also arise from trauma, surgical complications, or endocarditis.
• Ventricular Septal Defect (VSD): The presence of a VSD, which is a defect in the ventricular septum, necessitates repair to prevent complications such as heart failure or pulmonary hypertension.

2. Procedure

The surgical procedure for CPT® Code 33710 involves several critical steps to ensure the successful repair of both the sinus of Valsalva fistula and the ventricular septal defect.

• Step 1: The procedure begins with the establishment of cardiopulmonary bypass. This is achieved through bicaval or other venous and arterial cannulation, which diverts blood away from the heart and lungs, allowing the surgical team to operate on a still heart.
• Step 2: Once bypass is established, cardioplegia is initiated to protect the heart muscle during the procedure. This involves infusing a solution that temporarily stops the heart's activity.
• Step 3: The ascending aorta is then clamped, and an incision is made to open the aorta. This access allows the surgeon to visualize the sinus of Valsalva and identify the fistula.
• Step 4: The aortic valve cusps and coronary ostia are carefully inspected to assess any potential damage or complications that may need to be addressed during the repair.
• Step 5: The repair of the sinus of Valsalva fistula is performed using sutures or a patch made from pericardial or synthetic material, effectively closing the defect.
• Step 6: Following the repair of the sinus, the focus shifts to the ventricular septal defect. The VSD may be accessed through the aorta or via a separate incision in the right atrium, right ventricle, or left ventricle, depending on the surgical approach deemed most appropriate.
• Step 7: The ventricular defect is then repaired, similarly utilizing sutures or a patch to ensure a complete closure.
• Step 8: Finally, the ascending aorta is closed, and the patient is gradually weaned off cardiopulmonary bypass, allowing the heart to resume its normal function.

3. Post-Procedure

After the completion of the procedure, patients typically require close monitoring in a postoperative setting. This includes observation for any signs of complications such as bleeding, infection, or arrhythmias. The recovery process may involve pain management and gradual mobilization as the patient stabilizes. Follow-up care is essential to assess the success of the repairs and to monitor heart function over time. Additional imaging studies may be performed to ensure that both the sinus of Valsalva and the ventricular septal defect have been adequately addressed.