Figure legends
Figure1: A)V1-V5 shows QS pattern, and V1-V6 arch elevates 0.05-0.5Mv;B) V2-V4 shows QS pattern, and V2-V4 arch elevates 0.05-0.15mv.
Figure 2 A) Echo-interruption in the left ventricular septum near the apex was observed by color echocardiography, with a range of about 18.5mm and EF: 51%; B) Echo interruption at the apex of the ventricular septum, and the shunt layer at the ventricular septum stump was dissected. The echo interruption in the left ventricular plane and the right ventricular plane was 19mm, and 12mm, respectively; C) The enhanced echo of the occluder can be seen at the ventricular septum near the apex of the heart, and a small gap can be seen below the occluder with a width of about 1.9mm.
Figure 3: Myocardial CT reveals myocardium defect of 2.2x2.1cm in maximum cross-section at the apex of the ventricular septum.
Figure4: A) Coronary angiography (CAG) shows that the LAD is subtotal occlusion in the middle and distal segments, with blood flow TIMI2: 60% stenosis in the middle segment of LCX; TIMI3: diffuse 50-70% stenosis in the proximal segment of RCA; 60% stenosis in the proximal segment of posterior descending branch, with blood flow TIMI3; B) Angiography confirms ventricular septal perforation after apical myocardial infarction, with the defect of about 17mm in diameter. A right heart catheter was placed through the femoral vein under fluoroscopy. The right ventricular and pulmonary artery pressures were measured as RVP53/13mmHg (26mmHg) and PAP52/12 MMHG (24mmHg), respectively. A 260cm guide wire was successfully inserted into the right ventricle through the ventricular septal defect, and then sent into the pulmonary artery. The guide wire snare was inserted through transvenous sheath and pulled out through transvenous sheath pipe. The 28mm(14g) interventricular septum wall packer was sent to left ventricular lateral through14F transmit sheath pipe after successfully establishing the track. Next, the packer left tray umbrella was released and the sheath tube retreated at the same time. The right tray umbrella was released after completely blocking the ventricular septal defect. The left ventricular angiography confirmed there was no shunt in local part. Moreover, the auscultation noise was obviously reduced, and X-ray images showed that the occluder was in good shape, thus, the occluder was completely released. The postoperative left ventricular pressure was 114/6(41)mmHg.