CPT® Code 33726

1. Indications

The procedure for the repair of pulmonary venous stenosis is indicated in the following situations:

• Congenital Pulmonary Venous Stenosis This condition may be present at birth, leading to restricted blood flow from the lungs to the heart.
• Post-Surgical Stenosis Stenosis may develop following surgical repair of anomalous pulmonary vein connections, necessitating further intervention.

2. Procedure

The procedure for repairing pulmonary venous stenosis involves several critical steps:

• Initiation of Cardiopulmonary Bypass and Sternotomy The surgical process begins with the initiation of cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs, allowing the surgeon to operate on a still and bloodless field. A sternotomy is performed to gain access to the heart.
• Visualization of the Pulmonary Veins Once access is achieved, the pulmonary veins are visualized by making an incision through the atrium. For patients who have previously undergone repair, access is typically through the right atrium, allowing the surgeon to assess the extent and location of the stenosis, which may be localized to the previous anastomotic area.
• Incision of the Common Pulmonary Vein In cases of initial repair, the approach is through the left atrium to reach the edge of the septum. The common pulmonary vein, or confluence, is then incised along its length, and the incision is extended into each pulmonary vein by cutting distally into the lung until the stenotic area is adequately addressed.
• Preservation of the Adventitia During the procedure, the adventitia, which is the outer layer of the pulmonary veins, is left intact to maintain structural integrity.
• Suturing the Left Atrial Wall The divided edge of the left atrial wall is sutured to the adventitia of the pericardium, positioned away from the edge of the pulmonary veins. This is accomplished using a running absorbable suture in a circular pattern around the pulmonary veins, which helps control pulmonary venous bleeding into the left atrium without directly suturing the veins themselves.
• Completion of the Anastomosis After suturing the left atrial wall to the pericardium, the suture line is routed inward toward the common vein or confluence to ensure hemostasis at the anastomosis site.

3. Post-Procedure

Post-procedure care for patients who have undergone repair of pulmonary venous stenosis typically involves monitoring for any complications related to the surgery, such as bleeding or infection. Patients may require follow-up imaging studies to assess the success of the repair and ensure that blood flow through the pulmonary veins is restored. Recovery may vary based on the individual patient's condition and the extent of the surgery performed.