Highlights
- •The right ventricular incision is close and parallel to the infarct-culprit artery.
- •A large LV-patch, introduced via the VSR, gives wide-enough coverage.
- •The patches are fixed with large transeptal/transmural mattress sutures.
- •All sutures are a safe distance (1.5-2 cm) from the debrided defect edge.
- •BioGlue is inserted in the defect space only after the LV patch is secured.
Postinfarction ventricular septal rupture, or postinfarction ventricular septal defect
is rare but lethal if not repaired, and various repair techniques have been tried
over many years. However, there still remain problems of high mortality rates and
shunt recurrence, particularly in the acute phase and posterior defects. The extended
sandwich patch repair via the right ventriculotomy was developed to overcome those
problems. The 3 key features are, first, access and eventual closure through the low-pressure
right ventricle; second, using the septal defect for a portal to reach into the left
ventricle; and third, “sandwiching” the defect between 2 patches, both large enough
to be anchored by transmural sutures through relatively stable myocardium. Detailed
technical steps are presented here.
Keywords
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Article info
Publication history
Published online: August 03, 2022
Footnotes
Financial disclosures: The authors declare no conflicts of interest associated with this manuscript.
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