Left ventricular apex venting during deep hypothermia in a case of difficult re-entry into the mediastinum

The cardiopulmonary bypass techniques of peripheral cannulations and deep h ypothermia provide safe and controlled re-entry into the mediastinum, when the thoracic organs are contiguous with the sternum. In such cases, in orde r to prevent ventricular distention during cooling, left ventricular ventin g is very important but can be difficult. We made a small (3 cm) left-sided thoracotomy incision and inserted a left ventricular apical venting tube w hile cooling a patient with a large pseudoaneurysm of the ascending aorta, which was diagnosed 12 years after aortic valve replacement. We found that this technique was easy, safe, and useful to prevent ventricular distention during cooling.