Cook pasta according to package directions. When the pasta is done, drain and set aside.
Using a heavy bottomed skillet over medium heat add olive oil and sliced red onions and bell peppers. Saute and for a couple of minutes, then add a couple of cloves of garlic to the pan. When the onions and peppers have softened, remove from skillet and place on a plate. Wipe out the pan with a paper towel.
Saute the sausage round for about 8 to 10 minutes. Turn sausage over halfway through. The sausage should be lightly browned. While the sausage is cooking combine the prepared pesto and heavy cream in a small pot over low heat. Stir until the pesto and the heavy cream are combined. In a large bowl combine the cooked pasta, the cooked vegetables, and the browned sausage rounds. Drizzle the heated pesto sauce and stir until the pasta is completely coated.
Serve immediately. Garnish with Parmesan cheese if desired.