41-YEAR-OLD MAN was admitted with a 6-month history of worsening angina, dizziness, and dyspnea on exertion. His past medical history was significant for Hodgkin’s lymphoma, diagnosed at age 5, for which he was subsequently treated with chemotherapy and mantle radiation. On admission, his physical examination was notable for an asymmetrical pectus excavatum localized to the upper half of his sternum, and he was noted to have a harsh, crescendo/decrescendo systolic ejection murmur in the right second intercostal interspace radiating to the carotid arteries. Electrocardiogram revealed left ventricular hypertrophy. Cardiac catheterization revealed a focal 10% stenosis in the proximal third of the left main coronary artery, and all other coronary vessels were angiographically normal. Additionally, he was noted to have a calcified aortic valve and severely calcified ascending aorta, with a peak left ventricle (LV)-to-aortic gradient of 50 mmHg and elevated left ventricular filling pressures. The aortic valve area was 0.7 cm 2 by the Gorlin formula. The LV ejection fraction was 45% to 50%. The patient also had mild pulmonary hypertension. Because of the extensive calcification of the ascending aorta, a preoperative computerized tomography scan was performed, which revealed LV hypertrophy and extensive calcification from the aortic valve extending throughout the aortic arch. The upper thoracic cavity was asymmetrically smaller on the left, and marked atrophy of the paraspinal muscles and chest wall musculature was noted. On the computed tomography scan after radiation therapy, fibrotic changes were seen throughout the anterior mediastinum. A magnetic resonance imaging study of the neck and thorax confirmed the presence of normal, nondistorted airway anatomy. The patient was brought to the operating room, and general anesthesia was induced with a combination of midazolam, fentanyl, sodium thiopental, and pancuronium. Hemodynamic monitoring consisted of a left radial artery catheter, an Oximetric, pulmonary artery catheter, and continuous transesophageal echocardiography (TEE) (Omniplane, Sonos 5500: HewlettPackard, Andover, MA). Because of the frozen mediastinum, surgical exposure for the procedure was via a left posterolateral thoracotomy. The results of the surgery are seen on the intraoperative TEE (Figs 1 and 2). What procedure was performed?