Modified Sandwich technique
Kitagawa and associates modified the “sandwich” technique for multiple small anterior muscular septal defects. Using the transtricuspid route, they passed mattress sutures through the septum, continuing through the anterior wall of the ventricle away from the anterior interventricular coronary artery, and finally through a felt buttress effectively to close the defects by “sandwiching” them against the anterior wall of the heart (Figure 9).2,41