Surgical Closure of Apical Muscular Ventricular Septal Defects via a Right Ventriculotomy

Identification and surgical closure of apical muscular ventricular septal defects are associated with certain morbidity and mortality because of their location in the ventricular septum distal to the moderator band, making adequate visualization and complete closure from the right atrium almost impossible. However, the precise margins of apical VSDs can be readily identified by a small apical right ventriculotomy. We report two infant patients with congenital heart disease and apical muscular VSDs communicating between the left ventricular apex and the RV infundibular apex. Patient A was a 9-month old female who had a swiss-cheese type VSD (apical VSDs below the moderator band and one VSD at the high infundibular portion). Patient B was a 18-day old male who had coaractation of the aorta (CoA), patent ductus arteriosus (PDA), and multiple VSDs (subarterial doubly committed type VSD with apical muscular type VSDs). Their apical VSDs were closed with separate patches via apical right ventriculotomy. The associated cardiac defects were all corrected during the single operation. Good biventricular contractility without residual VSD were confirmed by 14-month follow-up. The successful outcome of these two patients indicates that surgical closure of apical muscular VSDs can be achieved safely and completely in early infancy through a limited apical right ventriculotomy.