Hybrid Approach: Ventricular Septal Defect Closure

The hybrid approach to closure of ventricular septal defects is applicable in a wide range of muscular ventricular septal defects. The key anatomical relationships to consider on the right ventricular aspect are the tricuspid valve, the moderator band, proximity to the free wall of the right ventricle and the pulmonary valve in the case of outlet defects. On the left side, obstruction of the aortic valve or left ventricular outflow tract may be an issue in outflow defects. The mitral valve is rarely a problem, but in cases where the mitral valve has abnormal attachments or where the anatomy is that of a repaired AVSD with a residual VSD, the left-sided valve structures can become relevant.