Revival of right thoracotomy to approach atrio-ventricular valves in reoperations.

A right thoracotomy was used to approach the atrio-ventricular (AV) valves in 8 patients who had previously undergone a cardiac operation through a midline sternotomy. Due to an extremely enlarged right heart, to a dilated ascending aorta, or to the presence of anteriorly placed aorto-coronary bypass-grafts, a repeated midline sternotomy was considered to involve the risk of massive hemorrhage in this group of patients. Cardiopulmonary bypass was instituted after cannulation of the right femoral artery and of the right atrium or venae cavae. The ascending aorta was controlled when deemed necessary. Since minimal dissection was required and the exposure of the AV valves was excellent, the operative procedure was uneventfully and expeditiously carried out in all cases. A right thoracotomy provides a convenient way to approach the AV valves in selected patients who have had previous heart surgery through a midline sternotomy.