The patient is positioned supine, with the left chest elevated to approximately 30 degrees by a roll beneath the shoulder. An anterolateral thoracotomy incision is made at the fourth intercostal space. The subcutaneous tissues are incised to expose the intercostals muscle. The intercostals muscle are incised at his insertion on the upper face of the lover coast, paying attention to the presence of the left mammary artery during the isolation of the structures. The pleural space is opened after de-insufflation of the lungs. The lung is retracted posteriorly, the pericardium opened just anterior to the left phrenic nerve. The pericardium is suspended with 2-0 Ethibond sutures.