Tabriz University of Medical Sciences Journal of Cardiovascular and Thoracic Research 2008-5117 10 2 2018 06 29 Aortic root replacement and valvuloplasty in a woman with severe pectus excavatum 115 117 10.15171/jcvtr.2018.19 EN Panagiotis Kalogris Kosmas Iliadis Gregory Amanatidis Alexandros Demis Anna Smyrli Konstantinos Petsios Journal Article 10.15171/jcvtr.2018.19 2017 11 20 2018 04 30 We describe a case of a 43-year old woman with Marfan’s syndrome, tricuspid valve regurgitation and severe pectus excavatum who required an aortic root replacement and valvuloplasty for an ascending aortic aneurism with aortic valve regurgitation and tricuspid valve regurgitation. There was a severe angulation of the sternum which was close to 1.5 cm to the column vertebrae. Such cases are quite rare and always a challenge for surgeons to achieve adequate exposure of the heart and prevent excessive cardiac compression. We present our access, a safe and efficient exposure of the heart in order to achieve the best outcome.