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Dextrocardia associated to situs inversus totalis is a rare congenital conditions (prevalence of 1:10,000) in which the organs are located in a symmetric or mirror position in the opposite side of the body. These individuals usually have a normal life expectancy and the same propensity to develop ischaemic coronary disease as the general population. We report a case of a 59-year-old female patient with a single-vessel obstructive coronary disease successfully resolved via a right anterior small thoracotomy on a beating-heart using the right internal thoracic artery as a conduit for 'left' anterior descending coronary artery.

• Reproducible surgery • Low mortality and early complications rate • Good early, mid and long-term results Take-home message The left thoracotomy is a safe alternative to median sternotomy for coronary artery bypass grafting on the beating heart, with low early complications and good mid and long-term results.

Third REDO-CABG is a challenge for the surgical team. Usually a patent mammary is the only graft working and the sternotomy becomes a risky procedure. Injury to a patent graft has been associated to a high mortality rate. Many different approaches have been proposed. We describe a novel technique to approach the right coronary artery through a right anterior small thoracotomy using the right mammary prolonged with saphenous vein for grafting the posterior descending artery on the beating heart. The technique is very simple and feasible because anatomically the right coronary artery and the right mammary are very close and the mobilization of the heart is minimal.

The Glenn operation involving anastomosis of the superior vena cava to the pulmonary artery has been performed for palliative operations of many cyanotic congenital heart diseases in addition to the single ventricle since the 1960s. The classic procedure is done via median sternotomy and cardiopulmonary bypass. The benefits of this procedure without the use of cardiopulmonary bypass remain mixed within reported series. Cases using this approach and off-pump technique together in Latin-America have not yet been reported in the scientific literature.

During the last few years, several minimally invasive operating techniques have been described to perform aortic valve replacements. We report a case of an acute aortic valve bacterial endocarditis, which was successfully dealt with a valve-replacement via a right anterior minithoracotomy through the third intercostal space.

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