Right atrial approach with a single oversized patch on the right ventricle (the septal obliteration technique)
Black and Cetin inserted a single large autologous pericardial patch and composite patch of Dacron lined with preserved heterologous pericardium respectively through the transtricuspid route without dividing the moderator band.3,4
Seddio and associates also described this technique using a large autologous pericardial patch after dividing the moderator band.42 Kitagawa and associates used a polytetrafluoroethylene patch, placed on the left ventricular side of the septum after dividing the moderator band (Figures 6A, 6B).2,41
These techniques are useful when multiple discrete defects are present in the posterior and apical parts of the septum, caudal to the moderator band.1-4,41,42 Intraoperative transesophageal echocardiography and cardioscopy from the left side of the septum via the aortic root have been employed for identification of the defects from the left side by these investigators.