1. Facile Minimally Invasive Cardiac Surgery via Ministernotomy
Steven R Gundry, O.Howard Shattuck, Anees J Razzouk, Michael J del Rio, Frederic F Sardari, Leonard L Bailey 
The Annals of Thoracic Surgery 
Volume 65, Issue 4, Pages (April 1998)
DOI: /S (98)

2. Fig. 1
Artist’s rendering of proposed skin incisions overlying upper or lower sternum. Initial sternal division for upper or lower ministernotomy is illustrated, as well as proposed extensions depending on the location of the cardiac structures underneath. In congenital heart operations, transverse division of the sternum is unnecessary. (Reprinted with permission from Gundry S. Aortic valve replacement via ministernotomy. Operative Techniques in Cardiac & Thoracic Surgery: A Comparative Atlas 1998;3(1):47–53.)
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

3. Fig. 2
Artist’s conception of surgical exposure and cannula placement for aortic valve replacement and for operations on the base of the heart. Pericardial edges are sewn to skin edges. Aortic cannulation and dual-stage venous cannulation as well as retrograde cardioplegia cannula insertion are all accomplished through the ministernotomy. Dark line on the aorta shows proposed aortic incision. (Reprinted with permission from Gundry S. Aortic valve replacement via ministernotomy. Operative Techniques in Cardiac & Thoracic Surgery: A Comparative Atlas 1998;3(1):47–53.)
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

4. Fig. 3
Artist’s rendering of surgical exposure and cannula placement for mitral valve repair or replacement. Arterial cannula and dual-stage venous cannula are placed in routine fashion while 24F venous cannula is inserted into the superior vena cava directly. The aortic cross-clamp is tied to the left skin edge to aid retraction. The dome of the left atrium is entered parallel to the right pulmonary artery. The left atrial incision can be extended beneath the superior vena cava or out onto the left atrial appendage. (Reprinted with permission from Gundry S. Aortic valve replacement via ministernotomy. Operative Techniques in Cardiac & Thoracic Surgery: A Comparative Atlas 1998;3(1):47–53.)
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

5. Fig. 4
Artist’s drawing of patient and surgical positioning for optimal exposure to aortic and mitral valves. Patient is positioned high on the operating table. Right shoulder area is available for the surgeon. (Reprinted with permission from Gundry S. Aortic valve replacement via ministernotomy. Operative Techniques in Cardiac & Thoracic Surgery: A Comparative Atlas 1998;3(1):47–53.)
The Annals of Thoracic Surgery  , DOI: ( /S (98) )