Postinfarction Ventricular Septal Defect: Right Ventricular Approach—The Extended “Sandwich” Patch

We introduce a novel technique of ventricular septal defect (VSD) closure through right ventricular incision and through the VSD. It should provide extended and better-anchored coverage of the VSD margin and create a completely leak-free “sandwich” double patch by using large interrupted horizontal mattress sutures only, with no incision in the left ventricle wall. The patch is sutured better with large transseptal/transmural mattress sutures, minimizing perioperative risk of shunt recurrence. The second patch at the right ventricular side is easily placed. The patch in our method is considerably smaller than in the infarction exclusion technique. This method of VSD repair via right ventricular incision and trans-VSD approach is safe and simple, and it has so far given good, safe, and completely leak-free outcomes.