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