Mitral Valve Replacement via Right Thoracotomy in a Patient With Marfan Syndrome and Severe Scoliosis After a Prior Bentall Procedure.

Mitral valve surgery is commonly performed through median sternotomy or right mini-thoracotomy, but both approaches can be challenging in patients with thoracic deformities. We report the case of a 37-year-old male patient with Marfan syndrome, severe scoliosis, and a history of prior Bentall procedure for acute type A aortic dissection, who developed heart failure due to severe mitral regurgitation. Given his anatomical complexity and surgical history, neither median sternotomy nor right mini-thoracotomy was deemed feasible. A right anterolateral thoracotomy was selected, and mitral valve replacement with a mechanical valve was completed uneventfully. This case suggests that right thoracotomy remains an alternative for mitral valve surgery in patients with complex anatomy, including severe scoliosis and previous aortic surgery.