title: Surgical closure of apical ventricular septal defects through a right ventricular apical infundibulotomy.
abstract: BACKGROUND
  We present a new understanding of the anatomic position of apical ventricular septal defects and its surgical relevance. These defects occur between the left ventricular apex and the infundibular apex, rather than between the left and right ventricular apices. Often a sizable apical recess, the infundibular apex lies anteriorly and inferiorly to the moderator band 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 (range, 48 to 217 days) underwent patch closure through an apical infundibulotomy, which allowed complete visualization of the muscular apical ventricular septal defect.
  
  
  RESULTS
  There were no early or late deaths at operation. No significant residual shunt at ventricular level was detected by postoperative two-dimensional and Doppler echocardiography. Intraoperative comparison of right atrial 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 growing well.
  
  
  CONCLUSIONS
  The successful outcome of these 4 patients indicates that surgical closure of apical ventricular septal defects can be achieved safely and completely in early infancy through a limited right ventricular apical infundibulotomy. Long-term follow-up of these and similar patients is needed to provide further evaluation of this approach.
authors.affiliation: Department of Cardiovascular Surgery, University of Padova Medical School, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Stellin
authors.forename: M
authors.initials: M
authors.lastname: Padalino
authors.forename: O
authors.initials: O
authors.lastname: Milanesi
authors.forename: M
authors.initials: M
authors.lastname: Rubino
authors.forename: D
authors.initials: D
authors.lastname: Casarotto
authors.forename: R
authors.initials: R
authors.lastname: Van Praagh
authors.forename: S
authors.initials: S
authors.lastname: Van Praagh
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006352:Heart Ventricles / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D008297:Male