Fig. 3

Steps of secondary closure of the septal defect. a A primary patch is undergoing additional covering of the comet-shaped secondary patch (asterisk). b The endoventricular polypropylene sutures (② in Fig. 1b) were succeeded by 2/0 braided sutures brought out to the interventricular groove (③ in Fig. 1b). This row was not only to complete the secondary closure of the septal defect but also to hold the external patch. It forms a hinge line between two parts of the secondary patch. The back side of the secondary patch (asterisk) is now shown