ABSTRACT
Introduction Ventricular septal defect (VSD) is the most common (approximately 20%) congenital heart disease.1 About 10-15% of these defects are muscular VSDs located entirely within the muscular portion of the septum. The most common location is the apex, followed by the mid and anterior septum. Occasionally the defects are multiple (‘Swiss cheese’ VSDs). Acquired muscular VSDs are very rare and may result from postmyocardial infarction or traumatic injury to the chest.1 Because muscular VSDs are frequently hidden within the coarse right ventricular (RV) trabeculations, they are difficult to localize through the standard surgical approach via the right atrium. Various different surgical approaches have been proposed, but still pose a remarkable challenge and carry certain morbidity and mortality.1
