Intraoperative echocardiography and double-patch device sandwiching the septum
In 2004, Brizard and associates developed a unique technique in which the discrete defects were located with intraoperative epicardial echocardiography and transfixed with a guide wire inserted directly through the right ventricular free wall.8 The multiple ventricular septal defects were then sandwiched with custom made multilayered double patches from both sides of the ventricular septum under cardioplegic arrest via a right atriotomy. Multiple patches were used for distantly located ventricular septal defects. For closely related ventricular septal defects, oversized patches were used for collective closure of the septal defects.8