For patients with congenital atrial septal defect, in the past, extracorporeal circulation has been used to perform atrial septal defect repair under cardiac arrest. The surgical closure of atrial defect does not require extracorporeal circulation, much less X-ray irradiation, and the operation is safe and convenient, with an incision of only 3 cm and a whole operation time of less than 1 hour. This procedure is not restricted by age, with quick recovery and shortened hospital stay, which greatly reduces the patient’s burden. This procedure is suitable for the treatment of various difficult atrial septal defects. This procedure requires preoperative, intraoperative, and postoperative transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and RT3DE of the patient to determine the ASD site, size, morphology, and relationship to the mitral and tricuspid valves and the position, morphology, and residual leak of the occluder. This is valuable for surgical procedure guidance and postoperative outcome evaluation.