Modified Sandwich technique
Kitagawa and associates modified the “sandwich” technique for multiple
small anterior muscular septal defects. Using the transtricuspid route,
they passed mattress sutures through the septum, continuing through the
anterior wall of the ventricle away from the anterior interventricular
coronary artery, and finally through a felt buttress effectively to
close the defects by “sandwiching” them against the anterior wall of
the heart (Figure 9).2,41