Trans-Atrial Approach to the “Swiss-Cheese” Ventricular Septal Defects: Sandwich Technique

The closure of Swiss-cheese multiple ventricular septal defects remains a difficult technical challenge and it is associated with increased mortality. Recently, the felt sandwich technique has been widely used to close muscular ventricular septal defects because the technique is simple, safe, effective, and reproducible. This technique may be useful, especially in complex cases, because it does not require prolonged surgical time. However, the use of numerous felt patches may disturb the movement of interventricular septum and cause cardiac dysfunction in infants. To avoid postoperative cardiac dysfunction, our current strategy is implemented to close muscular ventricular septal defects directly as much as possible. When the ventricular septal defect is considered unsuitable for direct closure, the felt sandwich technique is a useful tool that can be applied as needed by surgeons.