Since the beginning of surgery, there has been a problem with incision scars, which are not harmful to health but unsightly, especially in cardiac surgery, where the incision is traditionally located in the middle of the forehead and is very conspicuous. Patients never stop looking for beauty in addition to health, and doctors are always moving forward in the path of incision design. With advances in technology, we are able to make smaller, more discreet incisions while perfectly repairing the heart. Can all people and all heart surgeries use minimally invasive incisions? Of course not! In adults, the bones and soft tissues are tough and the range of motion is small, so minimally invasive incisions are difficult to reveal the operative field; in complex precordial disease, the operation is extensive and difficult, so minimally invasive incisions cannot be used. Therefore, in general, only intracardiac surgery can be done under minimally invasive incision: at present, in Fu Wai Hospital, the use of minimally invasive incision for atrial septal defect and ventricular septal defect is very mature, or lateral axillary incision, or small incision in the lower sternum. How do doctors choose? Parents of children also need to understand the mystery. First of all, it should be clear that regardless of the incision, the operation should be performed under extracorporeal circulation and cardiac arrest, and the incision should be able to reveal the intracardiac malformation completely. The skin and subcutaneous tissues of children, including the bones, are more flexible and easy to pull, and the field is relatively superficial after opening the chest, so the atrial defect or most of the ventricular defects can be repaired only by cutting the atria. The surgeon must follow the principle that everything is beneficial to the patient when doing the operation. Safety and long-term efficacy of the operation are the first factors to be considered, and finally the aesthetics of the incision, and the optimal plan is chosen after a comprehensive judgment. Secondly, is it possible to use both types of incisions for all children and all atrioventricular defects? Not exactly. The advantage of the lateral axillary incision is that the wound is concealed and beautiful, and it is not easy to lead to corpus cavernosum, but the disadvantages are obvious: the lungs need to be blocked when exposing the heart, and the operative field is deep, which is not conducive to exposing the left side of the heart and the pulmonary artery. Therefore, when the child weighs less than 10 kg, it is difficult to reveal the narrow rib space, difficult to reveal high ventricular defects (e.g., inferior dry ventricular defect), and when combined with pulmonary hypertension, friction and compression of the lung may lead to postoperative pulmonary complications, which make the lateral incision inappropriate. The advantages of a small incision in the lower sternal segment are that the incision is smaller and lower, which also meets the aesthetic requirements and can be easily achieved if the incision needs to be extended to deal with complicated cases, but it is still poorly exposed in high ventricular defects, and the incision may cause deformation and dislocation of the joint between the ribs and the sternum under tension in small infants (less than 7 kg), so it should be chosen with caution. In addition, minimally invasive incision is also inappropriate when simple atrioventricular defects are combined with other intracardiac malformations, such as atrioventricular defects combined with ectopic pulmonary venous drainage, ventricular defects combined with patent ductus arteriosus and varying degrees of pulmonary valve stenosis or right ventricular outflow tract stenosis, requiring exploration and more extensive operations. Except for these cases mentioned above, most children can be operated with minimally invasive incisions. Surgery is the gold standard for the treatment of precordial disease, and everything should be done with the premise of perfect repair of intracardiac malformations, safety and long-term results are the most important, and then aesthetics should be taken into account under this premise, rather than putting the root and the end in the first place, putting the so-called cosmetic incision in the first place and reducing the safety and surgical results.