Sandwich repair with two sheets of equine pericardial patch for acute posterior post-infarction ventricular septal defect.

A 74-year-old man, who had posterior post-infarction ventricular septal defect, was treated successfully by early surgical repair with a sandwich technique involving two sheets of equine pericardial patch. In this technique the ventricular septal defect (VSD) was exposed through a trans-infarction approach. The inside patch covered the VSD and ventriculotomy from the inside. The outside patch generously covered the infarcted myocardium. The two patches completely sandwiched the infarcted myocardium including the VSD and ventriculotomy with eighteen interrupted sutures. This technique ensures strong fixation of the VSD, reducing the risk of bleeding and recurrence of VSD, and also maintains the proper shape and size of the left ventricle without the danger of ventricular aneurysm formation.