Objective To introduce the experience of using a minimally invasive right ventricular surgical approach for the radical treatment of tetralogy of Fallot (TOF). METHODS Eighty-three patients with TOF were surgically treated from May 2005 to February 2008 using the transverse right atrial/pulmonary artery route. The right ventricular outflow tract was enlarged in 42 of these cases by trans-pulmonary annular patching (right ventricular incision length 5-20 mm); in the other 4 cases, the right ventricular outflow tract was unblocked through a small right atrial and right ventricular incision. The other 4 cases underwent right ventricular outflow tract evacuation through small right atrial and right ventricular incisions. The ventricular septal defect was repaired by continuous suture patching through the right atrial incision in 81 cases and through both sides of the right atrial/pulmonary artery incision in the other 2 cases. After intraoperative cessation of extracorporeal circulation, the systolic right ventricular pressure/systolic circulatory pressure (RVP/SAP) ranged from 0.3 to 0.81 (0.41±0.15) in 65 cases detected by direct cardiac surface puncture or by floating catheter; the systolic right outflow tract residual pressure difference (GRVP-PAP) ranged from 8 to 55 mmHg (21.35±10.54 mmHg). 10.54 mmHg). There was one case of early postoperative death. Conclusions The surgical approach to eradicate tetralogy of Fallot using a minimally invasive right ventricle is technically feasible and simple to perform; the early clinical outcome is satisfactory; and there is potential benefit for mid- to late-stage outcomes.