A 72-year-old woman presented with a post-infarction ventricular septal defect, presumably within 10 days after the onset of acute myocardial infarction. An emergency surgery was performed because of hemodynamic instability. Using the sandwich patch technique, we approached the posteriorly oriented defect through a right atriotomy and detached tricuspid valve. By avoiding either left or right ventriculotomy, additional damage to the already infarcted ventricle and risk of bleeding were avoided. The patient showed an uneventful postoperative recovery, with no residual shunt detected. A transatrial approach combined with a sandwich patch technique is a good alternative in cases where the pathological anatomy is suitable.
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