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