CPT® Code 33814

1. Indications

The procedure coded as CPT® 33814 is indicated for the surgical repair of an aortopulmonary septal defect. This condition may present with various symptoms and complications, necessitating intervention. The following are the explicit indications for performing this procedure:

• Congenital Heart Defect The presence of an aortopulmonary septal defect, which is a congenital anomaly that can lead to significant hemodynamic changes.
• Heart Failure Symptoms Patients may exhibit signs of heart failure due to the abnormal blood flow caused by the defect.
• Increased Pulmonary Blood Flow The defect can result in excessive blood flow to the lungs, leading to pulmonary hypertension and other complications.
• Failure to Thrive In pediatric patients, the defect may contribute to poor growth and development due to inadequate oxygenation and nutrition.

2. Procedure

The surgical procedure for the obliteration of an aortopulmonary septal defect involves several critical steps, which are detailed as follows:

• Step 1: Accessing the Heart The surgeon begins by accessing the heart through a median sternotomy or thoracotomy, which involves making an incision in the chest to provide visibility and access to the heart and surrounding structures.
• Step 2: Thymus Resection If necessary, the thymus gland is resected to facilitate access to the heart and surrounding tissues, ensuring that the surgical field is clear for the procedure.
• Step 3: Incising the Pericardium The pericardium, which is the fibrous sac surrounding the heart, is incised, and a section is harvested for later use as a patch graft to repair the defect.
• Step 4: Dissecting the Aorta and Pulmonary Artery The aorta and main pulmonary artery are carefully dissected free from surrounding tissues to allow for proper visualization and access to the defect.
• Step 5: Establishing Cardiopulmonary Bypass The aorta and the superior and inferior vena cava are cannulated to establish cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs during the surgery.
• Step 6: Cross-Clamping the Aorta Once cardiopulmonary bypass is established, the aorta is cross-clamped to stop blood flow, allowing the surgeon to work on the defect without blood circulation interfering.
• Step 7: Repairing the Defect The aorta and pulmonary artery are divided, and the aortopulmonary septal defect is repaired using sutures or a pericardial patch graft. In cases of larger defects, alternative materials such as allografts (homografts), xenografts, or synthetic materials may be used for the repair.
• Step 8: Closing the Incisions After the repair is completed, the chest incisions are closed, and chest tubes may be placed as needed to facilitate drainage and recovery.

3. Post-Procedure

Post-procedure care following the obliteration of an aortopulmonary septal defect is crucial for patient recovery. After the surgery, patients are typically monitored in a recovery area or intensive care unit to ensure stable vital signs and proper recovery from anesthesia. Chest tubes, if placed, are monitored for drainage and may be removed once output decreases. Patients may experience pain at the incision site, which can be managed with appropriate analgesics. The expected recovery period may vary, but patients are generally advised to limit physical activity for a specified duration to allow for healing. Follow-up appointments are essential to assess the surgical site, monitor heart function, and ensure that there are no complications arising from the procedure. Additional imaging studies, such as echocardiograms, may be performed to evaluate the success of the repair and the overall function of the heart.