Surgical repair of supposedly multiple defects within the apical part of the muscular ventricular septum

Abstract

Background. A distinct defect has been described within the apical part of the muscular ventricular septum, which has multiple orifices when seen from its right ventricular aspect. Closure has been suggested using umbrella devices introduced on a catheter. Such an intervention, however, can be technically difficult in small infants. Methods. We have recently seen two examples of this type of complex communication between the apexes of both left and right ventricles. Neither could be closed by catheterization. A surgical approach was used through a modified apical right ventriculotomy. We have also studied two autopsied specimens, which clarify the morphologic arrangement. Results. Both patients were closed successfully, with trivial residual shunt and good biventricular functions. The patients were clinically well at 2-year follow-up. Conclusions. Surgical division of right ventricular trabeculations makes it feasible to identify and repair the septal deficiency, which is a solitary hole. On the basis of our morphologic study, we offer an explanation for the anatomic arrangement that differs from the one proposed by recent previous investigators. If the ventricular incision is appropriately placed, our anatomic studies suggest that it is possible to visualize the solitary opening from its right ventricular aspect, and achieve surgical closure with a single patch.