CPT® Code 33774

1. Indications

The atrial baffle procedure, as described by CPT® Code 33774, is indicated for patients diagnosed with transposition of the great arteries (TGA). This congenital heart defect necessitates surgical intervention to correct the abnormal flow of blood between the heart and the lungs. The procedure is particularly indicated in the following scenarios:

• Transposition of the Great Arteries This condition is characterized by the aorta arising from the right ventricle and the pulmonary arteries arising from the left ventricle, leading to inadequate oxygenation of the blood.
• Associated Cardiac Anomalies The procedure may be indicated in patients with TGA who also present with additional cardiac defects such as ventricular septal defect (VSD) or subpulmonary stenosis, which can complicate the surgical approach and require a tailored operative plan.

2. Procedure

The atrial baffle procedure involves several critical steps to effectively repair transposition of the great arteries. The procedure is performed under general anesthesia and typically begins with the following steps:

• Accessing the Heart The surgeon gains access to the heart through a median sternotomy or thoracotomy. This approach allows for adequate visualization and manipulation of the cardiac structures. During this step, the thymus gland may be resected to facilitate access.
• Incising the Pericardium The pericardium, which is the fibrous sac surrounding the heart, is incised, and a large section is harvested for later use as a patch graft. This harvested pericardial tissue will be utilized to patch the atrial wall after the baffle is constructed.
• Establishing Cardiopulmonary Bypass The aorta and the superior and inferior vena cava are cannulated to establish cardiopulmonary bypass. This allows the heart to be temporarily stopped while maintaining circulation and oxygenation of the blood.
• Cross-Clamping the Aorta Once bypass is established, the aorta is cross-clamped to prevent blood flow during the procedure, allowing for a controlled surgical environment.
• Incising the Right Atrium The right atrium is incised to access the atrial septum. The atrial septum is then resected to create an opening for the baffle construction.
• Constructing the Atrial Baffle A patch of synthetic material, autologous pericardium, or an allograft is used to redirect systemic venous blood from the superior and inferior vena cava to the orifice of the mitral valve, which is characteristic of the Mustard type procedure. Alternatively, the Senning type procedure may be performed, utilizing flaps of the native atrial septum and atrial wall to create the intra-atrial baffles.
• Patching the Atrial Wall After the baffle is constructed, the atrial wall is patched using the previously harvested section of pericardium to close the incision made in the right atrium.

3. Post-Procedure

Following the completion of the atrial baffle procedure, the surgical team will take several steps to ensure proper recovery and monitoring of the patient. The sternum may be closed immediately or left open, with plans for closure in a subsequent procedure if necessary. Chest tubes are placed as needed to facilitate drainage and prevent fluid accumulation in the thoracic cavity. Post-operative care includes monitoring for any complications, assessing the patient's hemodynamic status, and ensuring adequate oxygenation. The recovery process will vary based on the individual patient's condition and any additional procedures performed during the surgery.