New "right side median" approach for postoperative re-coarctation of the aorta

Anatomic repair of postoperative recurrent coarctation of the aorta is surgically difficult using the conventional lateral approach. Therefore, we have developed a new approach to the stenotic aorta through a median sternotomy, involving division of the superior vena cava and left caudal displacement of the heart. This approach facilitates extensive dissection and mobilization of the descending aorta in the posterior mediastinum behind the heart and also facilitates direct anastomosis of the aortic arch and the descending aorta after resection of the stenosis. This approach is useful for anatomic repair of postoperative recurrent coarctation of the aorta and other posterior mediastinal procedures.