Apical right ventriculotomy
This approach has also been employed in diagnosed cases of the large
muscular defects that seem to be multiple because of the overlying right
ventricular apical septal trabculations.12-15When a
large acute marginal branch is present, a small right ventriculotomy of
approximately 2 cm is performed 4 mm lateral to the left anterior
interventricular coronary artery. When the acute marginal branch is less
prominent, a transverse incision is made above the acute margin of the
heart. Trabeculations overlying the margins of the septal defect were
taken down sharply to expose the edge of the defect. 5-0 polypropylene
sutures are placed full thickness at the superior margin of the defect,
maintaining pledgets on the left ventricular side. The ventricular
septal defect was closed with a Dacron patch (Figures
10A-10C).12-15