CPT® Code 33788

1. Indications

The procedure described by CPT® Code 33788 is indicated for patients with an anomalous pulmonary artery arising from the aorta. This condition can lead to various complications, including inadequate blood flow to the lungs, which may result in hypoxia and other cardiovascular issues. The reimplantation is performed to correct the abnormal positioning of the pulmonary artery, thereby restoring normal pulmonary circulation and improving overall cardiac function.

• Anomalous Pulmonary Artery The primary indication for this procedure is the presence of an anomalous pulmonary artery that originates from the aorta instead of the main pulmonary artery, which can lead to significant hemodynamic abnormalities.

2. Procedure

The surgical procedure for CPT® Code 33788 involves several critical steps to ensure the successful reimplantation of the anomalous pulmonary artery.

• Step 1: Accessing the Heart The procedure begins with the patient being placed under general anesthesia. The surgeon accesses the heart through a median sternotomy or thoracotomy, which involves making a surgical incision in the chest to provide visibility and access to the heart and surrounding structures.
• Step 2: Resection of the Thymus and Incision of the Pericardium Once access is achieved, the thymus gland may be resected to facilitate the surgical approach. The pericardium, the fibrous sac surrounding the heart, is then incised to allow for better manipulation of the heart and the vessels involved in the procedure.
• Step 3: Dissection of the Aorta and Pulmonary Arteries The surgeon carefully dissects the ascending aorta, the anomalous pulmonary artery, and the main pulmonary artery free from surrounding tissues. This step is crucial to ensure that the vessels are adequately mobilized for the subsequent anastomosis.
• Step 4: Ligation and Division of the Anomalous Pulmonary Artery The anomalous pulmonary artery is then ligated and divided, which involves cutting the vessel and securing it to prevent bleeding. This step is necessary to prepare for the connection to the main pulmonary artery.
• Step 5: Anastomosis of the Anomalous Pulmonary Artery An incision is made in the main pulmonary artery, and the anomalous pulmonary artery is anastomosed to it. This surgical connection restores the proper pathway for blood flow from the heart to the lungs.
• Step 6: Placement of Interposition Graft (if necessary) If the anomalous pulmonary artery cannot be directly anastomosed to the main pulmonary artery due to anatomical constraints, an interposition graft may be placed to bridge the gap and facilitate proper blood flow.
• Step 7: Closure of Chest Incisions After the anastomosis is completed, the surgeon closes the chest incisions. Chest tubes may be placed as needed to allow for drainage of any fluid that may accumulate in the thoracic cavity postoperatively.

3. Post-Procedure

Following the reimplantation procedure, patients typically require close monitoring in a postoperative setting to assess for any complications, such as bleeding or infection. The expected recovery period may vary depending on the individual patient's condition and the complexity of the surgery. Patients may experience pain at the incision sites, which can be managed with appropriate analgesics. Chest tubes, if placed, are monitored and removed once drainage decreases to a safe level. Follow-up appointments are essential to evaluate the success of the procedure and to ensure that the pulmonary circulation is functioning properly. Rehabilitation and gradual return to normal activities are encouraged as the patient heals.