Two-patch and right ventricle apex exclusion technique
Wu and Perez-Negueruela developed this technique of closing either
multiple large apical muscular or the Swiss-cheese septum using a
procedure that involved exclusion of the right ventricular apex through
the tricuspid route. Associated septal defects were closed
separately.50,62 A 10-Fr Foley catheter was railroaded
through a defect to facilitate visualization of the overall arrangement
by applying gentle traction. Two patches of bovine pericardium were used
to close the defects, excluding the apex of the right ventricle (Figure
12).62 The first bovine pericardial patch was sutured
at the upper edge of the deficient septum and moderator band using a 6-0
polypropylene suture. A second pericardial patch was used to close the
defects present between the moderator band and anterior free wall of the
right ventricle. Some investigators have used a 5-0 polypropylene purse
string suture to exclude the apical portion of the right ventricle,
thereby occluding multiple defects between the trabeculations of the
right ventricle.50,62