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