Two-patch and right ventricle apex exclusion technique
Wu and Perez-Negueruela developed this technique of closing either multiple large apical muscular or the Swiss-cheese septum using a procedure that involved exclusion of the right ventricular apex through the tricuspid route. Associated septal defects were closed separately.50,62 A 10-Fr Foley catheter was railroaded through a defect to facilitate visualization of the overall arrangement by applying gentle traction. Two patches of bovine pericardium were used to close the defects, excluding the apex of the right ventricle (Figure 12).62 The first bovine pericardial patch was sutured at the upper edge of the deficient septum and moderator band using a 6-0 polypropylene suture. A second pericardial patch was used to close the defects present between the moderator band and anterior free wall of the right ventricle. Some investigators have used a 5-0 polypropylene purse string suture to exclude the apical portion of the right ventricle, thereby occluding multiple defects between the trabeculations of the right ventricle.50,62