In 1988, Lock et al. first applied the double-sided umbrella to close the ventricular septal defect (VSD), which was later improved to the CardioSEAL double-sided umbrella, and in 1994, Sideris reported that the button patch method was used to seal the VSD. Since 1998, Amplatzer myocardial and perimembranous blocking devices have been successfully developed, and the initial application results are satisfactory, but more case observations and further postoperative follow-up are needed. Li Fuhai, Department of Pediatrics, Qilu Hospital, Shandong University, China I. Indications and contraindications (a) Indications 1. perimembranous VSD: (1) age: usually ≥3 years; (2) simple VSD with hemodynamic effects on the heart; (3) VSD with the upper edge ≥2 mm from the right aortic coronary valve, without aortic right coronary valve prolapse into the VSD and aortic regurgitation. 2. myocardial ventricular defect, usually ≥5 mm. 3. Residual shunt after surgical procedure. 4. Other: ventricular defect after myocardial infarction or trauma is not congenital, but the defect can still be closed using the technique of sealing the VSD of the precordial disease. (B) Contraindications 1. active endocarditis, intracardiac redundancy, or other infections causing bacteremia. 2. thrombus at the placement of the blocker, or venous thrombosis at the catheter insertion. 3. poor anatomic position of the defect, affecting the function of the aortic valve or atrioventricular valve after blocker placement. 4. severe pulmonary hypertension with bidirectional shunt. (1) Preoperative preparation 1. Preoperative cardiac catheterization routine. 2. Preoperative physical signs, electrocardiogram, X-ray chest radiograph and echocardiography. 3. Relevant laboratory tests. 4. 1 day before surgery intravenous antibiotic dose. 5. Oral aspirin 1 day before surgery, 3-5mg/(kg・d) for children, 3mg/(kg・d) for adults. (B) Routine diagnostic catheterization and echocardiography 1. left and right heart catheterization and cardiovascular angiography were performed under local or general anesthesia with femoral vein and femoral artery cannulation. 100 U/kg of heparin was routinely given, and the right heart catheterization was performed first to measure pressure and oxygen, and to detect pulmonary artery pressure and Qp/Qs. aortic and left ventricular pressure was measured with a pigtail catheter through the femoral artery, and left ventricular long-axis oblique angiography was performed to measure VSD The size of the VSD and its distance from the aortic valve were measured, followed by ascending aortogram to observe whether there was aortic valve prolapse and regurgitation. 2. Transthoracic ultrasound (TTE) or transesophageal ultrasound (TEE) was performed to evaluate the location, size, number, adjacent structures, and relationship with the valve of the VSD, and the distance of the edge of the defect from the aortic valve and septal aneurysm formation in the membrane VSD. The examination of the myocardial VSD in the proximal apical region and the surrounding anatomy can help in the selection of the occluder and the route. (C) Blocking method 1. perimembranous VSD blocking method: The most commonly used is the Amplatzer perimembranous VSD blocker and delivery system for blocking. (1) Establishment of the arteriovenous track: usually apply the right coronary catheter or other catheters through the femoral artery, aorta to the left ventricle, through the head end of the exploratory catheter into the right ventricle via the VSD, and then insert the 0 0 035 inch (1 inch = 2.54 cm = 0.0254m) soft tip long exchange guidewire through the catheter into the right ventricle and push it to the pulmonary artery or superior vena cava, and then insert the end hole catheter from the femoral vein through the end hole catheter into the collaterals, over the The guidewire from the pulmonary artery or superior vena cava is then pulled out from the femoral vein to establish a femoral vein-right atrium-right ventricle-left ventricle-femoral artery track. (2) Insert a suitable long sheath along the track from the femoral vein end to the right atrium to meet the right coronary catheter (kissing catheter technique), insert the long sheath and dilator tube together along the guidewire to the aortic arch, withdraw the dilator tube inside the long sheath, then slowly withdraw the long sheath to the left ventricular outflow tract, push the exchange guidewire and right coronary catheter from the arterial end to the tip of the left ventricle, the head end of the long sheath placed in the left ventricle then points to the apex, and then the arterial end is replaced by a Then the arterial end is replaced by a pigtail catheter, inserted into the left ventricle, and the exchange guidewire is withdrawn. (3) Placement of the blocker: A suitable size blocker is selected and connected to a dedicated delivery guidewire and delivery catheter to maintain the blocker in an asymmetric position. Then, the blocker is inserted into the delivery system via the long sheath and delivered to the end of the long sheath. Under the guidance of TEE/TTE and X-ray fluoroscopy, the long sheath is retracted to release the left disc and adhere to the ventricular septum, and after determining the good position, the blocker is embedded in the VSD at the waist and the long sheath is retracted to release the right disc. The position of the blocker, the presence of shunt and valve regurgitation were observed under TEE/TTE surveillance, followed by left ventriculography to confirm the proper position and shunt, and ascending aortic angiography to observe the presence of aortic regurgitation and aortic valve morphology. (4) Release the blocker: After satisfactory results of X-ray and ultrasound examination, the blocker can be released and the long sheath and catheter can be removed and compression can be applied to stop the bleeding. 2. Methods of blocking myocardial ventricular septal defect: (1) Establishment of arteriovenous track via VSD: Since myocardial VSD can be located in the middle of the ventricular septum or close to the apex, it is technically different from membrane VSD blocking. The left femoral artery, aorta, left ventricle, right ventricle, right internal jugular vein (or right femoral vein) track is usually established. (2) Placement and release of the blocker: ①cis route: the long sheath is inserted into the right ventricle through the internal jugular vein (or femoral vein), and then the blocker is placed in the left ventricle through the VSD as usual; ②reverse route: when the myocardial VSD is close to the apex, and the right ventricular surface has many myocardial trabeculae or the right ventricular surface defect is small and difficult to be inserted in the cis route. After the blocker was placed, it was observed under TTE/TEE and left ventriculography, and the results were good: the blocker was properly placed; there was no or only a small amount of shunt; there was no obvious aortic valve and atrioventricular regurgitation. Postoperative management and follow-up1 Postoperative ward monitoring, clinical and electrocardiographic monitoring, and echocardiography within 24 hours, and follow-up after 5-7 days of postoperative observation. 2 Heparinization 24 hours after surgery, antibiotics intravenous application for 3 days. 3 Oral aspirin 3-5 mg/(kg・d) for children and 3 mg/(kg・d) for adults for 6 months after surgery. 4 Follow-up 1, 3, 6, 12 months after surgery. The ECG, chest X-ray and echocardiogram will be reviewed at 6 and 12 months after the operation. V. Complications 1. complications of cardiac catheterization. 2. arrhythmias: premature ventricular beats, ventricular tachycardia, bundle branch block, and atrioventricular block, the latter of which may be delayed. 3. dislodgement and embolization of the blocking device. 4. aortic or tricuspid regurgitation. 5. residual shunt. 6. hemolysis. 7. cardiac and vascular perforation. 8. neurological complications: headache, stroke, etc. 9. local thrombosis and peripheral vascular embolism. Peripheral vascular embolism.