At work, we often see ventricular septal defects in patients aged about 30 years old with cardiac ultrasound showing: ventricular septal defect, 20-30 mm in diameter, with bi-directional shunts at the ventricular level. There are still some patients in this category who can be operated on. I have recently performed a case myself with good results. Now summarize it for the reference of all patients. The patient, male, 30 years old, presented with “chest tightness and shortness of breath after activity with coughing up blood for 1 month”. The patient had not undergone any cardiac examination before. The outpatient ultrasound suggested: ventricular septal defect, 24 mm in diameter, bi-directional shunt at the ventricular level, and 99 mmHg pulmonary artery pressure. The patient and his family actively requested surgery. After admission, a right heart catheterization was performed: it suggested that the patient had a left-to-right shunt at the ventricular level after oxygenation. The patient was given surgical treatment after adequate preoperative preparation. Considering the patient’s preoperative inspiratory air ventricular level bidirectional shunt, a hole was punched on the polyester patch and a one-way valve gate technique was used intraoperatively. The operation went smoothly, with good postoperative recovery, and the patient was discharged 7 days after surgery. Postoperative ultrasound suggested that the ventricular level shunt disappeared and the pulmonary artery pressure decreased significantly. In conclusion: some of the older simple ventricular septal defects with high pulmonary artery pressure, with adequate preoperative adjustment, well-designed surgical operation and patient postoperative recovery, the patients still had good long-term results.