Surgical closure of apical ventricular septal defects through a right ventricular apical infundibulotomy

Background. We present a new understanding of the anatomic position of apic al ventricular septal defects and its surgical relevance. These defects occ ur between the left ventricular apex and the infundibular apex, rather than between the left and right ventricular apices. Often a sizable apical rece ss, the infundibular apex lies anteriorly and inferiorly to the moderator b and and is the most leftward part of the right ventricle. Methods. Four patients (2 boys and 2 girls) with a mean age of 109 days (ra nge, 48 to 217 days) underwent patch closure through an apical infundibulot omy, which allowed complete visualization of the muscular apical ventricula r septal defect. Results. There were no early or late deaths at operation. No significant re sidual shunt at ventricular level was detected by postoperative two-dimensi onal and Doppler echocardiography. Intraoperative comparison of right atria l and pulmonary arterial blood samples showed a difference of less than 5%. At a mean follow-up of 18 months, all the patients are asymptomatic and gr owing well. Conclusions. The successful outcome of these 4 patients indicates that surg ical closure of apical ventricular septal defects can be achieved safely an d completely in early infancy through a limited right ventricular apical in fundibulotomy. Long-term follow-up of these and similar patients is needed to provide further evaluation of this approach. (C) 2000 by The Society of Thoracic Surgeons.