Limited apical left ventriculotomy approach
This approach has been employed for multiple apical muscular defects inaccessible through the transtricuspid route. When viewed from the left side of the septum, of course, a single discrete defect is observed.11,46-49 A short “fish-mouth” incision about 1 cm long is made at the apex of the left ventricle away from, and parallel to the interventricular coronary arteries on a non-vented heart filled with cardioplegia solution, avoiding injury to the anterior papillary muscles of the mitral valve. The recommended incision is usually smaller than the size of the defect. The ventriculotomy is closed by a double layer of continuous polypropylene suture, sandwiching a portion of the patch used to close the septal defect without injuring the coronary arteries (Figure 11).2,11,41,43,46-50