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The minimally invasive approach involves a limited skin incision, which can be as short as 3.5 cm. Sternal incision can be avoided in some cases, while in others only the lower one-third of the sternum is divided.
The sternum is flexible enough in children that the lower two halves of the partially divided bone can be separated to gain access to the heart. The heart-lung machine is connected through ultra-thin-walled, highly flexible venous cannulas.
This allows enough room for the introduction of instruments into the mediastinum. This is ideal for closure of simple secundum atrial septal defects, though it also has been used for closure of more complex primum ASDs, as well as in ventricular septal defects, complete AV canal defects, and in selected patients with Tetralogy of Fallot.
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