Aortic and mitral valve surgery through a superior ministernotomy in pectus excavatum associated with Marfan's syndrome

The combination of chest wall abnormalities such as pectus excavatum and cardiac disease requiring operative correction represents a clinical challenge to the surgeon. We report two cases of patients with Marfan's syndrome and severe pectus excavatum in whom cardiac operations were successfully performed using a superior 'T inverted' ministernotomy. This approach allowed safe isolation of the target cardiac structures, provided excellent operative exposure and enhanced chest wall stability by preserving the integrity of the lower sternum.