folding of the tissue while permitting a relatively large amount of tissue to create the tissue fold the device 400 includes struts 408 which support the tissue chamber 402 and help to form a desired shape when the tissue chamber 402 is expanded the device 400 is loaded with a number of fasteners 411 and a flexible filament 413 such as suture 415 or the like the filament 413 may form a closed loop with a knot 417 or other suitable method of securing one part of the filament 413 to another to maintain tension on the filament 413 as described below the filament 413 may extend out of one of the tissue ports 410 and re enter the device through another tissue port 410 as shown in fig3 the filament 413 may be covered by a flap 415 which covers the filament 413 while permitting release of the filament 413 through a free edge referring to fig5 the fasteners and filament 413 are shown positioned above the tissue port the fasteners 411 are mounted to a stylet 418 having a pusher 419 that is positioned in a stylet tube 422 the stylet 418 has a sharp tip 424 which.