Separate patch closure of multiple apical defects
Many investigators have successfully used a transatrial approach when multiple muscular defects exist cranial to the base of the anterior papillary muscle, and in the middle part of the apical muscular septum. These defects can reliably be closed by dividing the moderator band, and the body of the septomarginal trabeculation. For posteroinferior and inlet defects, the septal leaflet of the tricuspid valve may require temporary detachment for optimal exposure.7,12,14,38,41 A transpulmonary or an approach via a right ventriculotomy have been described for anterosuperior muscular defects. Knitted Dacron, and polytetrafluoroethylene synthetic patches have been employed by various investigators, including us.7,12,14,38,41