Atrial septal defect is the most common type of simple congenital heart disease, and its treatment has become very mature. With the development of medicine, it is no longer the goal of doctors to simply cure a disease, but to make the cure simple, safe, non-invasive or minimally invasive, with fast recovery and less cost is the next step we pursue. In terms of the treatment of atrial septal defect, in addition to the classical atrial septal defect repair via a median chest incision with general anesthesia (see Figure 1), eight levels of minimally invasive treatment for atrial septal defect have been developed, which I summarize as follows: 1. Level 1 minimally invasive: median sternal “7” incision surgery (see Figure 2). The characteristics of this surgery: general anesthesia and extracorporeal circulation are still required, and there is no need to completely split the sternum longitudinally. Its chest trauma is half of the classic surgery, and the chest incision is low and more aesthetic. There is no difficulty in surgery. 2.Second level minimally invasive: small right axillary incision (pediatric) or right anterolateral incision (adult) (see Figure 3). The surgery is performed through the fourth intercostal entry in the right chest. General anesthesia and extracorporeal circulation are still required, but there is no skeletal damage, and the trauma is smaller than that of the first level of minimally invasive surgery, and the location is hidden and aesthetically pleasing. However, it is difficult to intubate extracorporeal circulation during surgery, which increases the risk of surgery. 3. The third level of minimally invasive surgery: atrial septal defect repair through the right thoracic incision via femoral artery cannulation (see Figure 4). The location of the right thoracic incision is the same as the previous level of minimally invasive surgery, but smaller. Extracorporeal circulation is established through a small incision in the right groin to expose the femoral arterial cannula. This procedure is a modified version of the previous level of surgery, and the surgical approach is similar, but because the chest does not need to be intubated, the surgical operation is less invasive and the procedure is safe and feasible. 4. Fourth level of minimally invasive surgery: transthoracoscopic assisted atrial septal defect repair (see Figure 5). The surgical approach and extracorporeal circulation intubation are similar to the previous level of surgery. The thoracoscopic assisted view and light source make the surgical view clearer and the operation safer, so the chest incision is smaller, less than 5 cm. 5. Fifth level of minimally invasive: full thoracoscopic atrial septal defect repair (see Figure 6). The atrial septal defect repair is done through three holes in the right chest wall. The surgeon completely relies on the screen view provided by the thoracoscope to complete the surgery, and cannot see the surgical field directly, which completes the transition from “low surgery” to “head surgery” in surgery. This surgery is the most minimally invasive surgical method in extracorporeal circulation surgery. The sixth level of minimally invasive surgery: transthoracic atrial septal defect closure (see Figure 7). Under general anesthesia, an incision of about 4 cm is made through the right chest, the right atrial surface is sutured and the right atrium is punctured, and the atrial septal defect is sealed with the assistance of ultrasound. The procedure does not require extracorporeal circulation, and is simple, convenient and reliable. 7. Level 7 minimally invasive: transcatheter X-ray mediated atrial septal defect closure (see Figure 8). No general anesthesia or extracorporeal circulation is needed, only local anesthesia in the groin area, and the atrial septal defect can be sealed with a catheter via the intravenous system under X-ray guidance. This method is currently widely used, but there are indications required. And X-ray has radiation damage to patients and medical personnel. 8.Eighth level of minimally invasive: B ultrasound-mediated transcatheter septal defect closure (same as Figure 8). The method and indications are similar to those of the previous level, except that the mediating method is changed from X-ray to ultrasound. It is currently the most minimally invasive way to treat atrial septal defects because it avoids radiological damage to the patient and medical personnel from X-rays. In summary, there are several treatment options available for atrial septal defects. Of the eight treatment modalities described above, the 4th, 5th and 8th level surgical modalities will become the mainstream modality for the treatment of atrial septal defect, while the other modalities will become transitional modalities in the process of medical development and will eventually be eliminated. At present, if a medical unit is still using the classical median chest incision for atrial septal defect repair, it can be basically concluded that the working method of cardiac surgery in that medical unit is backward, and patients who visit it should pay attention to it.