Total failure of sternal fusion without other developmental anomalies of the chest and abdominal wall is rare. We report on a 52-year-old man with a total cleft sternum associated exclusively with an ostium secundum type atrial septal defect, a large cono-ventricular septal defect and pulmonary stenosis, who underwent successful surgical repair of the congenital heart disease and of the sternal anomaly by direct approximation of the freshened sternal remnants to the midline without interposition of tissue graft or inert prosthesis. This technique should be considered and attempted first as a better surgical option even in adult patients.