Techniques :  Depending on the type of surgery planned, the heart may be approached through median sternotomy, left or right thoracotomy. The problems encountered could be due to haemomhage, hypotension, cardiac arrhythmias including ventricular fibrillation and cardiac arrest. In cases where such complications are anticipated, cardio pulmonary by pass pump is kept standby and the procedure could be converted to an open one, if needed.