Closure of atrial septal defects without cardiopulmonary bypass: The sandwich operation Wiwat Warinsirikul, MD, Surapot Sangchote, MD, Pirapat Mokarapong,

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Closure of atrial septal defects without cardiopulmonary bypass: The sandwich operation Wiwat Warinsirikul, MD, Surapot Sangchote, MD, Pirapat Mokarapong, MD, Sant Chaiyodsilp, MD, Supreecha Tanamai, MD The Journal of Thoracic and Cardiovascular Surgery Volume 121, Issue 6, Pages 1122-1129 (June 2001) DOI: 10.1067/mtc.2001.113324 Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 The sandwich patch. A , Left-side view; B , lateral view; C , right-side view. The Journal of Thoracic and Cardiovascular Surgery 2001 121, 1122-1129DOI: (10.1067/mtc.2001.113324) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 The larger patch was grasped with an O'Shaugnessy clamp covered with a rubber tube. The Journal of Thoracic and Cardiovascular Surgery 2001 121, 1122-1129DOI: (10.1067/mtc.2001.113324) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 The patch was passed into the right atrium through the superior purse-string suture and guided by the right index finger. AV node , Atrioventricular node; CS , coronary sinus; IVC , inferior vena cava; PV , pulmonary vein; RV , right ventricle; SVC , superior vena cava; TV , tricuspid valve. The Journal of Thoracic and Cardiovascular Surgery 2001 121, 1122-1129DOI: (10.1067/mtc.2001.113324) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Three external transfixing sutures were placed. The Journal of Thoracic and Cardiovascular Surgery 2001 121, 1122-1129DOI: (10.1067/mtc.2001.113324) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Stapling was carried out along the edge of the patch guided by the left index finger. The Journal of Thoracic and Cardiovascular Surgery 2001 121, 1122-1129DOI: (10.1067/mtc.2001.113324) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Schematic drawing of intraoperative transesophageal echocardiography demonstrated closure of ASD with the sandwich patch. LA , Left atrium; LV , left ventricle; RA , right atrium; RV , right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2001 121, 1122-1129DOI: (10.1067/mtc.2001.113324) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions