Hybrid closure of multiple apical muscular septal
defects
Hybrid, perventricular delivery of the device involves direct access to
the right ventricle via a surgical incision, which may be median
sternotomy, or a limited subxiphoid, parasternal or infra-axillary
incision.23-25,51-55,69 The procedure is performed on
a beating heart without fluoroscopy using continuous transesophageal or
epicardial echocardiographic guidance. The approach to device delivery
include direct puncture into the right ventricle, direct transthoracic
puncture, and placement with the heart open under cardiopulmonary
bypass.55,68 In some institutions, device closure is
the treatment of choice if the defect is difficult to access, such as in
the apical or anterior muscular septum, and in the setting of the
Swiss-cheese septum.19-28,51-55