Two years ago we had, for technical reason to resuscitate right thoracotomy (RT) to approach the mitral valve. Since then we have used it in 23 patients. 18 of them had had at least one operation through a medium sternotomy. In 5 cases the right approach was electively used, as first choice to repair or replace the mitral valve. Intracardiac surgery was performed routinely with moderate hypothermia and controlled ventricular fibrillation with the aorta unclamped. Only in one case, an unexpected aortic incompetence forced us to cross-clamp the aorta and replace the valve using crystalloid cold cardioplegia. 14 patients underwent mitral valve replacement. In 5 cases a leaking mitral prosthesis was successfully reattached and in 4 cases the native valve was repaired. 2 patients died (9%) for reasons unrelated to the technique. We did not have any case of air embolism. CONCLUSIONS 1) RT is very useful to approach the mitral valve, specially in patients who previously had: a) several sternotomies, b) postoperative mediastinitis, specially if treated by omentoplasty, c) coronary artery bypass; 2) the good view to the mitral valve obtained with the aorta unclamped, make us think if the mitral repair should elective done through this approach.