The complexity of operation upon the heart and great vessels and the difficulties of physiological postoperative management make it desirable to have an operative exposure which is simple, rapid, and least disturbing to respiration. Having employed the median sternotomy in over 30 patients requiring total heart-lung by-pass, we are convinced that it has advantages over bilateral thoracotomy. It is the purpose of this paper to advocate its use for most intracardiac procedures.
Milton1 was among the first to suggest median sternotomy, and those interested in the subject would profit by reading his excellent paper. It was also recommended by Lilienthal,2 Roberts and Wilson,3 and, more latterly, Holman, for pericardiectomy4; Shumacker, for pulmonary stenosis,5 and Julian, for various intracardiac procedures.6
Initially we used the conventional transverse incision through the fourth interspace on the right and the third interspace on the left, with a V-shaped transection