Surgical closure of apical ventricular septal defects through a right ventricular apical infundibulotomy Giovanni Stellin, MD, Massimo Padalino, MD,

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Presentation transcript:

Surgical closure of apical ventricular septal defects through a right ventricular apical infundibulotomy Giovanni Stellin, MD, Massimo Padalino, MD, Ornella Milanesi, MD, Maurizio Rubino, MD, Dino Casarotto, MD, Richard Van Praagh, MD, Stella Van Praagh, MD The Annals of Thoracic Surgery Volume 69, Issue 2, Pages 597-601 (February 2000) DOI: 10.1016/S0003-4975(99)01333-8

Fig 1 Patient 1. Four-chamber view of apical muscular ventricular septal defect (lower arrow), which lies below the moderator band (upper arrow). (LA = left atrium; LV = left ventricle; MB = moderator band; RA = right atrium; RV = right ventricle; VSD = ventricular septal defect.) Note that the ventricular septal defect is between the left ventricular apex and the infundibular recess (below the moderator band), not between the apices of the left and right ventricles. The Annals of Thoracic Surgery 2000 69, 597-601DOI: (10.1016/S0003-4975(99)01333-8)

Fig 2 (A) Opened normal right ventricle (RV). The apex of the right ventricle inflow is proximal to the apex of the outflow tract (infundibulum). There normally is a muscular partition, including the moderator band (MB), between the inflow and the outflow apices. The outflow or infundibular apex typically is further to the left and closer to the left ventricular apex. (PB = parietal band; PV = pulmonary valve; SB = septal band; TV = tricuspid valve.) (Reproduced with permission from Van Praagh and colleagues [1].) (B) A waxed specimen of a normal heart viewed from above. Part of the anterior wall of the right ventricular inflow and outflow have been removed to expose the septal–moderator band junction and the entry into the infundibular apex (Inf. Apex). (Ao = aorta; PA = pulmonary artery; RAA = right atrial appendage; SVC = superior vena cava.) (Reproduced with permission from Kumar K, Lock JE, Geva T. Apical muscular ventricular septal defects between the left ventricle and the right ventricular infundibulum. Diagnostic and interventional considerations. Circulation 1997;95:1207–13 [3]. The Annals of Thoracic Surgery 2000 69, 597-601DOI: (10.1016/S0003-4975(99)01333-8)

Fig 3 The heart of an 8-day-old twin girl with visceral heterotaxy, asplenia, double-outlet right ventricle with only subpulmonary conus, inversus atria, L-loop ventricles, with the aortic valve posterior and to the left of the pulmonary valve, and severe subaortic and aortic valve stenosis. (A) Opened left-sided right ventricle. The right ventricular exit of the apical ventricular septal defect (VSD) involves the infundibular (Inf Apex) apex, not the right ventricular apex (RV Apex). (Inn = innominate artery (left-sided); PB = parietal band; PDA = patent ductus arteriosus (right-sided); PV = pulmonary valve). (Modified from Van Praagh and colleagues [4].) (B) Opened right-sided atrium and right-sided left ventricle (LV). Large apical ventricular septal defect (VSD) is present. (AVC = atrioventricular canal; CAVV = common atrioventricular valve; HPV = hepatic vein.) (Reproduced with permission from van Praagh S, Geva T, Friedberg DZ, et al. Aortic outflow obstruction in visceral heterotaxy: a study based on twenty postmortem cases. Am Heart J 1997;133:558–68 [4]. The Annals of Thoracic Surgery 2000 69, 597-601DOI: (10.1016/S0003-4975(99)01333-8)

Fig 4 Diagrammatic presentation of the apical infundibulotomy parallel to the distal portion of left anterior descending (LAD) coronary artery. Inset shows the exposed apical ventricular septal defect (VSD). In this diagram and in some cases of apical ventricular septal defects, the defect extends above and below the moderator band (MB). (MPA = main pulmonary artery; other abbreviations, see Figs 2 and 3.) The Annals of Thoracic Surgery 2000 69, 597-601DOI: (10.1016/S0003-4975(99)01333-8)