Introduction

Apical muscular ventricular septal defects (VSDs) are surgically challenging because of their deep location within the trabeculated right ventricle, often resulting in difficult intraoperative localization and residual shunting.

Aim

This study reports the early feasibility of a structured three-step intraoperative localization strategy, termed the GIPMER 3-Method Approach (Govind Ballabh Pant Institute of Postgraduate Medical Education & Research), developed to assist in identifying apical muscular VSDs during surgical repair.

Material and methods

This single-center prospective feasibility case series included 5 pediatric patients with apical muscular VSDs who underwent surgical closure over a one-year period following standard preoperative evaluation. A structured three-step intraoperative localization strategy (the GIPMER 3-Method) was applied via a limited right ventricular apical ventriculotomy. Outcomes were assessed using intraoperative transesophageal echocardiography (TEE) and postoperative transthoracic echocardiography (TTE) at 48 hours and at 1 month.

Results

Complete closure was achieved in all 5 patients, with no residual VSD detected on intraoperative or early postoperative imaging. Median cardiopulmonary bypass time was 78 minutes (range: 70–90), and median aortic cross-clamp time was 42 minutes (range: 35–50). No major early postoperative complications, including arrhythmias or low cardiac output, were observed.

Conlusions

In this small prospective case series, the GIPMER 3-Method Approach demonstrated technical feasibility for early localization of apical muscular VSDs. While early outcomes were favorable, these results should be interpreted as preliminary, and larger studies with longer follow-up are required to evaluate safety, durability, and comparative effectiveness against established techniques.