Figure 1.

Transesophageal echocardiogram, 4-chamber view, showing (A) ventricular septal defect and (B) short axis with color Doppler of left-to-right shunt. C, Intraoperative photograph showing deployment of an Amplatzer septal occluder device through the ventriculotomy under direct visualization. D, The patch exclusion technique with a bovine pericardial patch on top of the Amplatzer septal occluder device in the left ventricle secured with 2-0 Ethibond MH pledgeted sutures going through the septum, occluder device, and then the patch.