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Background Acquired ventricular septal defect (VSD) is a life-threatening condition that occurred after a myocardial infarction (MI). The timing of the intervention remains very debated but it is crucial to choose the right surgical technique to obtain a stable and complete repair. Methods We report the case of an acquired VSD that occurred after a MI without obstructions of coronary arteries (MINOCA). The defect was promptly treated with a double patch plus glue sandwich technique. Results At the end of the procedure, echocardiographic data showed no residual shunt, and no major adverse cardiac and cerebrovascular events were reported during postoperative days or 6 months follow-up. Conclusion Our report suggests that MI's mechanical complications can occur even after a MINOCA.

Objective We performed closure of apical muscular ventricular septal defects (VSDs) using the sandwich technique and assessed its role in the treatment of the defects. Methods Twenty-one patients (nine males and 12 females) underwent VSD closure at a mean age of 15.4 months (range, 1 month to 6 years) and a mean weight of 8.3 kg (range, 4 to 20 kg). Associated cardiac malformations were present in all of the patients. VSDs were exposed through the tricuspid valve and also from the left ventricular (LV) side through a coexisting large perimembranous VSD or through the mitral valve through an interatrial septostomy. All the apical muscular VSDs were closed using the sandwich technique. Results There were no hospital deaths, and the postoperative course was uneventful in all patients. There was no residual shunt in 13 patients, and a minimal residual shunt (diameter ≤2 mm) was observed in four patients. Mild residual shunt (diameter ≤4 mm) was observed in two patients. At the latest follow-up, all the residual shunts had disappeared except in one patient. The wall motion of the interventricular septum and cardiac function were normal in all the patients one month after surgery. All patients were free of cardiac medications. Conclusions We conclude that the sandwich technique is safe and reliable. Even in cases when a residual shunt is present, the shunt tends to decrease with time. Further experience and longer follow-up of these patients are necessary to conclude whether this technique is applicable to neonates and young infants. doi: 10.1111/jocs.12104 (J Card Surg 2013;28:301–305)

Background: We determined the beneficial effect of the adventitial inversion technique on reducing the patency rate of false lumens in acute aortic dissection (AAD) compared with the sandwich technique using Teflon felts. Methods: Between 2003 and 2008, 65 consecutive patients with DeBakey type I AAD underwent emergent surgery. To obliterate a false lumen, the sandwich technique was used in 35 patients (group TS) before October 2006 and the adventitial inversion technique was used in 30 patients (group AIT) subsequent to October 2006. The false lumen patency was evaluated with computerized tomo-angiography (CTA). Results: There were three operative deaths (AIT [n = 1]; TS [n = 2]). The operative morbidity rate was not different (AIT = 17.2%, TS = 21.2%). Follow-up was completed in 56 patients (90.3%) with a mean duration of 12.2 ± 4.9 months in the group AIT and 31.8 ± 19.8 months in the group TS. During the follow-up period, there were no deaths or aortic events. In 53 patients (AIT [n = 26]; TS [n = 27]), a postoperative one-year CTA was obtained and compared with that of immediate postoperative one. The patency rate in the immediate postoperative period was 30.8% in group AIT and 63.0% in group TS (p = 0.019). On the follow-up CTA, it was 15.4% in group AIT and 48.1% in group TS (p = 0.018), respectively. Conclusions: The adventitial inversion technique can be performed safely and obliterate the false lumen more effectively than the sandwich technique. The adventitial inversion technique might decrease the incidence of reoperations related to aneurysmal changes and improve survival or event-free survival. (J Card Surg 2010;25:548-553)

We describe two cases where postinfarction ventricular septal defect (VSD) was treated with a new technique. Application of direct ultrasonography to the right ventricular (RV) wall enables the surgeon to visualize the region and perform appropriate incision into the right ventricle and trabecula resection. The VSD is sealed with gelatin-resorcin-formal (GRF) glue between two patches, one placed on the left ventricular side and the other on the right ventricular side. RV incision provides easy bleeding control and the "sandwich technique" using two patches and GRF sealing provides geometric preservation of the left ventricular shape and prevents residual shunt.