Objective To evaluate the efficacy of right lateral small incision ventricular septal defect repair and postoperative quality of life. Methods 488 cases investigated aged 6-15 years with right lateral small incision ventricular septal defect repair as the right group, and 185 cases investigated aged 6-l5 years with median open ventricular septal defect repair as the median group in the same period were randomly selected. The recent efficacy, long-term efficacy and postoperative health-related quality of life of the 2 groups were compared. The indicators of recent efficacy included extracorporeal circulation time, myocardial block time, postoperative pleural fluid volume, in-hospital death, complication status and postoperative hospitalization time, and the indicators of long-term efficacy included long-term symptoms, signs, echocardiogram, chest X-ray and electrocardiogram findings, and the postoperative health-related quality of life was measured by the Chinese version of TACQOL (TNO- AZL Children’s Quality of Life) scale. Results The amount of pleural fluid in the right group was significantly less than that in the median group [(106.7±85.2) ml vs (146.7±75.6) ml, t=5.603, P=0.000]. there was no statistically significant difference in extracorporeal circulation time, aortic block time, postoperative hospital stay, in-hospital mortality, and complication rate between the 2 groups (P>0.05). the incidence of corpus cavernosum in the 2 groups [0 vs 1.6% (3/185), X2=413.041, P=0.000], physical status on the TACQOL scale [(29.6±2.8) points vs (28.1±3.0) points, t=4.843, P=0.000], motor function [(31.2±1.1) points vs (30.5±1.6) points, t=5.139, P= 0.000], self-care ability [(31.9±0.4) points vs (31.6±0.8) points, t=5.130, P=0.000], cognitive ability [(29.9±3.2) points vs (26.9±4.2) points, t=7.902, P=0.000], positive emotion [(13.4±2.2) points vs (12.6±2.1) points , t=3.394, P=0.000] differed significantly, with the right group outperforming the right-center group. There were no statistically significant differences between the 2 groups in other indicators of long-term outcome and other dimensions in the TACQOL scale (P>0.05). Conclusion The right lateral small incision ventricular septal defect repair has satisfactory efficacy and better postoperative quality of life. It has been more than 10 years since October 1994, when congenital heart disease correction via small right lateral incision was carried out, and after continuous exploration, 1486 cases of various congenital heart surgeries were completed by April 2007, including atrial septal defect, ventricular septal defect, tetralogy of Fallot, partial endocardial cushion defect, left coronary artery right ventricular fistula, Ebstein’s malformation, main pulmonary artery septal defect The recent results are satisfactory, including complete pulmonary venous malformation drainage, and double outlet of the right ventricle. However, there is a lack of comprehensive and scientific evaluation of the long-term efficacy of the procedure, whether it is in accordance with the concept of minimally invasive surgery, and the impact of the procedure on the physiological, psychological, and social aspects of the children. The aim of this study was to investigate the near- and long-term outcomes and health-related quality of life of 488 cases of simple direct visual repair of ventricular septal defect via small right lateral incision in open chest (right side group) done from October 1994 to April 2004 at Beijing Fu Wai Cardiovascular Hospital, and to compare them with 185 cases of randomly selected median open chest of the same age group during the same period The children with ventricular septal defect repair (median group) were compared to determine the overall minimally invasive results of the small right lateral incision procedure. With the clinical research on the pathophysiology and surgery of congenital heart disease, the concept of minimally invasive cardiac surgery came into being in this setting. The use of various small incisions has improved, and the mortality rate for certain simple congenital heart disease procedures has become one of the key targets for surgeons to explore. It has been more than 10 years since the small right lateral incision open-chest congenital heart surgery was carried out in October 1994, and after continuous exploration, a total of 1486 cases of various congenital heart surgeries were completed by April 2007, including atrial septal defect, ventricular septal defect, tetralogy of Fallot, partial endocardial cushion defect, left coronary artery right ventricular fistula, Ebstein’s malformation, main pulmonary artery septal defect, complete pulmonary vein malformation drainage, right ventricular double outlet, etc. The recent results are satisfactory and popular among children and parents. However, there is a lack of unified, comprehensive and scientific evaluation of the long-term efficacy of the procedure and whether it is in accordance with the concept of minimally invasive surgery. There is no unified and scientific standard for the evaluation of minimally invasive surgery. At present, the commonly used evaluation indexes are as follows. ① Intraoperative indicators: including the size of the incision, the difficulty of surgery and extracorporeal circulation establishment, exposure, operation time, extracorporeal circulation time, aortic block time, and the difficulty of decortication; ② Postoperative indicators: including the amount of chest fluid drainage, respiratory and circulatory system recovery, incision healing, the presence of serious complications, deformity correction, and ICU and hospitalization time; ③ Long-term indicators : including deformity correction, chest complications including pectus excavatum, pectoral muscle and breast dysplasia, etc., and questionnaires to investigate patients’ subjective evaluation of incision scar and surgery, etc. In this study, we proposed the concept of “overall minimally invasive” for the evaluation of minimally invasive surgery. The overall minimally invasive concept refers to the minimally invasive surgery not only in the surgical procedure and postoperative recovery phase, but also in the reduction of long-term physiological, psychological and social effects of the surgery on the patient. ”The “health-related quality of life measurement” is a good method to determine the physical, psychological and social health of an individual or a group of people in a comprehensive manner. The TACQOL scale is a universal health-related quality of life scale for children aged 6-15 years, jointly developed by the TNO Institute for Prevention and Health and Leiden University Hospital in the Netherlands, which can be used to assess the quality of life of children with various medical conditions and to compare the health status of different groups of people with different medical interventions. The scale consists of 7 dimensions, including physical status, motor function, self-care, cognitive ability, interaction, positive emotion, and negative emotion, with 8 items in each dimension, and higher scores indicate higher quality of life. A study has used this scale to study the health-related quality of life of Chinese school students aged 6-15 years and found that it has good reliability and validity (Cronbach’s α coefficient of 0.8995, Spearman’s correlation coefficient of each dimension r=0.289-0.790, P<0.05), which is suitable for this study to investigate the quality of life of children with different surgeries. quality of life investigation. In the present study, we selected recent efficacy indicators such as extracorporeal circulation time, myocardial block time, postoperative pleural fluid volume, postoperative hospitalization time, in-hospital mortality, complication occurrence, and distant symptoms, signs, echocardiography, chest radiographs, and electrocardiograms to evaluate the therapeutic effect of direct visualization repair of simple ventricular septal defect via small right lateral incision, and the TACQOL scale to understand patients' postoperative Health-related quality of life was used to evaluate the overall minimally invasive effect of the small right lateral incision simple ventricular septal defect repair. Since the TACQOL scale requires the survey to be performed on children aged 6 to l5 years, we selected children in this age group as the study population. This study showed that the near-term outcome of right lateral small incision simple ventricular septal defect repair was satisfactory, and the postoperative pleural fluid volume was even lower than that of median open chest; the postoperative mortality and complications were not statistically different from those of median open chest surgery (P>0.05). Long-term follow-up revealed a higher incidence of corpus cavernosum in median open-chest surgery, while this drawback was not found in right lateral mini-incision surgery; echocardiography, chest radiography, and electrocardiography did not reveal any significant difference in long-term outcomes between the 2 procedures. Sternal bleeding is one of the main sources of pleural fluid after median open heart surgery. Bleeding in this area can only be stopped by filling and closing the bone marrow cavity with bone wax, and too little bone wax may cause an increase in postoperative chest volume, while too much bone wax may cause poor healing of the sternum, increasing the possibility of developing a corpus cavernosum in the distant future. The small right lateral incision is not only small, but also hidden between the anterior axillary line and the posterior axillary line, and the natural drooping of the upper arm can cover most of it, and the incision is made through the lower edge of the pectoralis major muscle and subconsciously free in the deep surface of the pectoral muscle to the 4th intercostal chest, where there is no important tissue structure and far from the breast and the muscle tissue of the anterior chest wall, avoiding the damage to the related blood vessels and nerves; without splitting the sternum, the integrity of the thorax is maintained, and not only the postoperative chest volume This not only significantly reduces the postoperative chest volume, but also completely avoids the possibility of developing a pectus excavatum in the long term. The TACQOL scale survey showed that the physical condition, motor function, cognitive ability and overall assessment of children with simple ventricular septal defect repair with a small right lateral incision were significantly better than those of children with median open chest. The integrity of the thorax of the right lateral mini-incision surgery was not destroyed, and complications such as corpus cavernosum will not occur in the long term, which will not significantly affect the function of the thorax; at the same time, the surgical scar is hidden in the axilla, and no obvious surgical scar remains on the chest, which will not regularly evoke the memory of the child and parents about the precordial disease and surgery, thus reducing the excessive concern and worry of parents or children about their physical condition, which may be the cause of the right lateral mini-incision surgery. These may be the reasons for the significantly better physical condition and motor function after the small lateral incision surgery than in children with median open heart. School is the main living environment for children aged 6 to 15 years old, and because of the importance Chinese children attach to group life and the relatively heavy study load, all the physical, psychological and social (interpersonal) discomforts of children are concentrated, highlighted or even exaggerated in the school environment or in the accomplishment of study tasks, so that the difference in cognitive abilities of children with the 2 surgical procedures may not be true intellectual differences, but rather a reflection of other physical, psychological, and social differences (although there were no significant differences in psychological and social dimensions, e.g., we did not find differences in interaction skills, positive emotions, and negative emotions in our study), and similarly differences in physical condition and motor function should be considered as such. Missing analysis in this study: Returned letters were the most important cause of missing follow-ups, regardless of the reason (possibly due to a change in the patient’s mailing address, unknown mailing address left, etc.), but they were not related to the content of the study, and are referred to as “random missing” in follow-up studies, in which case the observed data were used as the basis for statistical analysis. In this case, the statistical analysis was based on the observed data, and the results were unbiased. The non-random missingness in the right lateral and median groups was less than 16% and 15%, respectively, which is acceptable. In conclusion, the right lateral small incision simple ventricular septal defect repair has satisfactory near-term and long-term treatment results, provides better postoperative quality of life, is fully compatible with the concept of minimally invasive surgery, and has a significant overall minimally invasive effect.