Staged approach with an initial banding of the pulmonary trunk
As suggested above, in small infants with combined perimembranous and inlet muscular defects separated by a thin muscle bundle, some investigators have preferred initial banding of the pulmonary trunk, thus promoting growth of the muscle bar containing the conduction axis which separates the defects.14,16,17,43 The hope is that the passage of time will permit growth of the muscle bar interposing between perimembranous and muscular defects, thus allowing placement of sutures to secure separate patches at the time of second-stage surgery.16,17,38-40 This strategy is helpful in preventing iatrogenic heart block.
Apical ventricular septal defects