Minimally invasive congenital cardiac surgery continues to evolve and remains challenged by the technical advance in catheter devices developed to percutaneously treat heart defects without cardiopulmonary bypass surgery. Public pressure towards 'incisionless' operations must be balanced with the collective safety of the surgical procedures. Twenty pediatric patients underwent corrective surgery due to congenital heart septal defects by means of limited skin incision midline sternotomy, between October 1997 and July 1998. Early results were quite encouraging. The shortest skin scar amounted to 5.5 cm. Modification of the midline sternotomy technique continues to evolve with advantages including excellent cosmetic results, similarity with the classical mediastinal access and an easy switch to wide sternotomy in emergency cases. This cosmetic alternative to the renewed submammary and thoracotomy approaches seems to be potentially effective in all age groups. The widespread use of limited skin incision midline sternotomy in all cardiac surgery should be a subject of future investigations.

Keywords: minimally invasive cardiac surgery, cardiac surgery, congenital heart defects