Ventricular septal defect is the most common simple congenital heart defect in cardiac surgery, with an operative mortality rate of less than 1%. The most common surgical procedure is a median sternotomy with extracorporeal cardiac arrest, which can repair most ventricular septal defects alone or in combination with other cardiac anomalies, but the incision is long and superior, which affects the aesthetics and requires clothing with a round neck or higher to cover the upper scar. The surgery requires incision of the sternum, blood transfusion, cardiac arrest, and the risk of post-operative corpus cavernosum. With the improvement of surgical techniques and patients’ requirements for aesthetics, small right axillary incision, femoral arteriovenous cannulation with full thoracoscopic assistance, and small direct view septal defect repair with femoral arteriovenous cannulation have gradually emerged, with hidden incisions that are not easily detected, no sternotomy, less postoperative bleeding, significantly faster postoperative recovery than median incision, and shorter hospital stay and recovery time, but still requiring extracorporeal circulation and blood transfusion. Advances in imaging and materials science have facilitated the emergence of minimally invasive blocking surgery. It is small and low incision, aesthetic, less traumatic, only part of the sternum is incised, low incidence of corpus cavernosum, and beneficial to psychological health without extracorporeal circulation and cardiac arrest, without incision of the right atrium, pulmonary artery, and right ventricular outflow tract, no strain on the internal structures of the heart, avoiding postoperative decline in cardiac function, pulmonary infection, PH-related complications low bleeding, and generally no blood transfusion. Intraoperative esophageal ultrasound monitors in real time whether there is residual shunt after blockage and whether there is any effect on valve function, etc. The operation time is short, fast channel extraction, and postoperative hospital stay is short. It is not restricted by age, and the incision is smaller at younger age. Both the doctor and patient are protected from X-ray radiation. It also deals with some cardiac malformations (atrial septal defect, patent ductus arteriosus, pulmonary valve stenosis), and if blockage fails, surgical repair with extracorporeal circulation can be established by extending the incision, without the need for transport, with high parental acceptance of blockage failure and relaxed surgical indications. However, it also has disadvantages: part of the sternum still needs to be incised, silk or wire fixation is required, hemostasis is difficult after a small incision, and a drainage tube needs to be placed. What is worthy of the parents’ attention is that with more experience, not only the ventricular septal defects with blood flow deviating to the outflow tract, such as the inferior stem type and the intracricial type, but also most of the membranous ventricular septal defects (except for those deviating to the tricuspid valve) can be blocked through the left sternal intercostal approach (see the figure below). This technique does not require sternotomy, smaller incision (generally less than 1 cm), less bleeding (generally less than 5 ml), no hemostasis, shorter operation time (generally less than 45 minutes), no risk of chicken chest, no drainage tube, thus solving the disadvantages of lower sternotomy, more in line with the interests of the child, and more reflecting the concept of minimally invasive.