1. Repair of secundum atrial septal defect: limiting the incision without sacrificing exposure 
Junaid H Khan, MD, Doff B McElhinney, MD, V.Mohan Reddy, MD, Frank L Hanley, MD 
The Annals of Thoracic Surgery 
Volume 66, Issue 4, Pages (October 1998)
DOI: /S (98)

2. Fig 1
A small incision across two intercostal spaces is performed (3 to 8 cm). A partial sternotomy starting from the xiphoid and extending to the sternomanubrial junction is used (dashed line).
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

3. Fig 2
A pursestring suture in the right atrial appendage is used to retract the appendage inferiorly and provide exposure of the aorta. The upper aortic pursestring suture is for the cannula; the lower is for the vent needle.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

4. Fig 3
Standard aortic cannulation is used. Inferior vena caval (IVC) and superior vena caval (SVC) cannulas are advanced through pursestring sutures in the atrium. Both cavae are snared. The SVC cannula is placed through the lower pursestring and the IVC cannula through the upper. The cannulas cross in the atrium. The cannulas are not yet snared in this figure.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

5. Fig 4
A vein retractor is placed under the crossing venous cannulas for retraction, and a cardiotomy suction catheter is placed in the coronary sinus. An autologous pericardial patch (P) is used to close the defect with a continuous suture technique.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )