Left thoracotomy for aortic and mitral valve surgery in a case of mediastinal displacement due to pneumonectomy

A 68-year-old male patient with low cardiac output was referred for a redo aortic valve replacement (AVR). Four years earlier, he had undergone a left pneumonectomy for a bronchial carcinoma. Due to the severe shift of the mediastinum into the left chest, as well as to adhesions of the right lung to the sternum, a median sternotomy was thought undesirable. AVR was performed through a left anterior thoracotomy through the fourth intercostal space. The following day, the worsening of a pre-existing mitral insufficiency due to leaflet tethering was diagnosed. Mitral valve annuloplasty was then achieved via a left posterior thoracotomy through the sixth intercostal space. Three weeks later, the patient had recovered a normal hemodynamic and spontaneous breathing. A left thoracotomy should be considered as an alternative approach for valve surgery in case of severe heart displacement.