Since the beginning of surgery, there has been a problem with incision scars, which are not harmful to health but unsightly, especially in heart surgery, where the traditional incision is 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 operation with relatively simple precordial disease can be completed under minimally invasive incision: our hospital is very mature in using minimally invasive incision for atrial septal defect and ventricular septal defect, or lateral axillary incision, or small incision in the lower sternum. How does the surgeon choose? The parents of the child also need to understand the mystery. First, it is important to be clear: regardless of the incision, the operation must be performed in extracorporeal circulation, in cardiac arrest, and the incision must be able to completely reveal the intracardiac malformation. The skin and subcutaneous tissues, including the bones of children are more flexible and easy to pull, and the field of surgery is relatively superficial after opening the chest, so the atrial defect or most of the ventricular defects can be repaired only by incising the atria. The surgeon must follow the principle that everything is beneficial to the patient when performing the operation. Safety and long-term efficacy of the operation are the first factors to be considered, and finally the aesthetics of the incision is the last, and the optimal solution is chosen after a comprehensive judgment. Secondly, we have to answer: are these two incisions available for all children and all atrioventricular defects? Not really. The advantage of the lateral axillary incision is that the wound is concealed and aesthetic, and it is less likely to lead to corpus cavernosum, but the disadvantages are also obvious: the lungs need to be blocked when the heart is exposed, the operative field is deeper, and it is not favorable to reveal 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 in small infants (less than 7 kg) may cause deformation and dislocation of the joint between the ribs and the sternum under tension, so it should be chosen with caution. In addition, a minimally invasive incision is also contraindicated when a simple atrioventricular defect is combined with other intracardiac malformations, such as atrioventricular defect combined with ectopic pulmonary venous drainage, ventricular defect combined with patent ductus arteriosus and varying degrees of pulmonary valve stenosis or right ventricular outflow tract stenosis, requiring exploration and more extensive manipulation. Except for the above mentioned cases, most children can be operated with minimally invasive incisions. Again, the question is: Can a lateral incision cause scoliosis? Will a lateral incision affect a girl’s breast development? Can a small incision in the lower sternum lead to corpus cavernosum? Can a lateral incision or a small subpectoral incision be used for tetralogy of Fallot? Here are the answers to each question. Question 1: The lateral incision can sometimes cause dislocation of the small joint between the ribs and the spine due to the high pulling force on the rib cage, which may develop into scoliosis in the long term. Question 2: The lateral incision taken by our hospital is outside the range of the pectoralis major muscle and is still some distance from the breast, so it usually does not affect breast development. Question 3: The small incision in the lower part of the sternum splits only the lower 1/2 or 2/3 of the sternum, and the upper part remains intact, so there is usually no chicken breast. Problem 4: The radical treatment of tetralogy of Fallot requires resection of the right ventricular hypertrophic muscle and widening of the pulmonary artery, so only in a very mild degree of tetralogy of Fallot – without transannular patching – can a small incision of the lower sternal segment be attempted, which can still meet the needs of the operation, while a lateral incision cannot reveal the operating area on the side of the pulmonary artery, and the surgical effect is greatly reduced and Therefore, minimally invasive incisions are not recommended for complex precordial disease. Surgery is the gold standard for the treatment of precordial disease, and everything should be based on the premise of perfect repair of intracardiac malformations, safety and long-term results are the most important, and under this premise, aesthetics should be taken into account, 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.