Ventricular septal defect repair after acute myocardial infarction using the double-patch technique without ventriculotomy

The double-patch-without-ventriculotomy technique represents a less aggressive surgical option for post-ischaemic ventricular septal defect (VSD). It allows repair without placing sutures in the ischaemic and perilesional frail tissue. VSD closure is obtained through two composite semirigid patches placed on both sides of the defect and kept together by two button-seam fashion sutures. The left patch must exceed the VSD maximum diameter by 2 cm, while the right patch can be 0.5 cm smaller. The technique requires a biventricular approach through transverse aortotomy and right atriotomy. A vessel loop is passed through the defect, helping the parachuting of the left side patch over the VSD. After positioning the left patch, the ends of the button-seam sutures are passed through the right patch. The right patch is then parachuted through the atriotomy, covering the VSD right side. Finally, both patches are tied together, and valvular and subvalvular apparatus checked for correct functioning.