title: Apical ventricular septal defects: follow-up concerning anatomic and surgical considerations.
abstract: BACKGROUND
  Apical ventricular septal defects (VSDs) are difficult to visualize and close transatrially. We described their distinctive anatomic features, which have seldom been documented angiocardiographically and pathologically, in order to develop an effective approach for their surgical management.
  
  
  METHODS
  Fourteen postmortem cases, two explanted hearts, 9 successfully operated patients, and 1 unoperated living patient were included in this report. Angiocardiographic documentation of the apical VSD was available in 14 of 16 (87.5%) of the postmortem and transplanted cases, and in 6 of 10 (60%) of the living patients. Echocardiograms were available in 23 of all 26 cases (88%).
  
  
  RESULTS
  Severe associated malformations were present in 14 of 16 (87%) of the pathologically documented cases. Large VSDs allowed extensive communication between the left ventricular and the right ventricular sinuses in 4 patients. In 12 of the pathologically documented cases and in the 10 living patients, the left ventricular apex communicated with the right ventricular apical infundibular recess.
  
  
  CONCLUSIONS
  Extremely large apical VSDs with severe biventricular dysplasia and dysfunction may require cardiac transplantation. Large apical VSDs can be successfully closed through a small apical infundibulotomy. This approach, applicable even in small infants, can avoid pulmonary artery banding or left ventriculotomy.
authors.affiliation: Department of Surgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. gaskill@a1.tch.harvard.edu
authors.forename: Stella
authors.initials: S
authors.lastname: Van Praagh
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Norman B
authors.initials: NB
authors.lastname: Berman
authors.forename: Michael F
authors.initials: MF
authors.lastname: Flanagan
authors.forename: Tal
authors.initials: T
authors.lastname: Geva
authors.forename: Richard
authors.initials: R
authors.lastname: Van Praagh
mesh_terms: D000790:Angiocardiography; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006346:Heart Septum / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male