The “Felt Sandwich Technique”
Several authors have described this technique, approaching the septum through the transtricuspid route for multiple muscular defects located just underneath the moderator band or at the apex of the heart, where it is difficult to place sutures, and hence making the defects unsuitable for direct closure.7,44,79 A 3F Nelaton catheter (Bard, Haverhill, Mass) was railroaded through the septal defect. The Nelaton catheter led an oversized circular polyester felt patch mounted on a 4-0 braided polyester suture. The suture ends were then passed through a slightly smaller polyester felt patch on the right ventricular side of the septum. The braided polyester suture was then tied, thereby sandwiching the septum between two polyester felt patches (Figure 8).7,44,79