Apical right ventriculotomy
This approach has also been employed in diagnosed cases of the large muscular defects that seem to be multiple because of the overlying right ventricular apical septal trabculations.12-15When a large acute marginal branch is present, a small right ventriculotomy of approximately 2 cm is performed 4 mm lateral to the left anterior interventricular coronary artery. When the acute marginal branch is less prominent, a transverse incision is made above the acute margin of the heart. Trabeculations overlying the margins of the septal defect were taken down sharply to expose the edge of the defect. 5-0 polypropylene sutures are placed full thickness at the superior margin of the defect, maintaining pledgets on the left ventricular side. The ventricular septal defect was closed with a Dacron patch (Figures 10A-10C).12-15