Dual-Patch Technique with Ventricular Septal Defect Closure for Straddling Chordae

Surgical repair of ventricular septal defects (VSDs) with straddling atrioventricular (AV) valve chordae is challenging due to the risk of disrupting valve integrity. We report the successful use of a dual-patch technique in a 5-month-old girl (6.1 kg) with Down syndrome, presenting with a large inlet VSD, secundum atrial septal defect (ASD), and straddling chordae involving both AV valves. Ventricular septal defects closure was performed via right atriotomy using 2 glutaraldehyde-treated autologous pericardial patches placed on the superior and inferior septal margins, encasing the chordae without division. Mitral and tricuspid valve clefts were repaired, and the ASD was closed primarily. Postoperative echocardiography showed no residual VSD and only mild AV valve regurgitation. This approach preserved valvular geometry and avoided conduction disturbance. The dual-patch technique offers a physiologic and conservative solution when conventional VSD repair is precluded by straddling chordae. It avoids chordal translocation or reimplantation, maintaining the native architecture and function of the AV valves.