Objective To explore the application of cardiac operation under direct vision through Lower median ministernotomy,and to search the new methods to improve the orthodox cardiac operation under direct vision.Methods The method of the cardiac operation under direct vision through lower median ministernotomy was used to 296 cases with heart disease who needed cardiac surgery,including 250 cases with congenital heart disease,40 cases with rheumatic heart disease,5 cases with left atrial myxom and 1 case with coronary heart disease.Results All cases performed the cardiac operation under direct vision through lower Median ministernotomy successfully without death and any residual.Conclusion The cardiac operation under direct vision through lower median ministernotomy can be used in majority cardiac operation under direct vision,it has well surgical and cosmetic result,but cannot be used in treating some patients with complex cardiac deformity or large heart.