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Background and aim of the study: The aim of the present study was to investigate the importance of the modality of pericardial incision (lateral versus anterior) onto postoperative right ventricular systolic function by comparing echocardiographic parameters in patients undergoing minimally invasive or traditional mitral valve repair Materials and methods: 34 patients (mean age 52�12 years; 27 males) with severe mitral regurgitation due to mitral valve prolapse were prospectively and randomly assigned to traditional (sternotomy) operation (Group A, 17 pts) or minimally invasive surgery with right antero-lateral thoracotomy (Group B, 17 pts). The pericardial approach consisted in an anterior reversed T incision for traditional surgery and in a lateral one for mini-invasive surgery. Two-dimensional transthoracic echocardiography was performed pre- and 6 months post surgery to evaluate right ventricular function by tricuspid annular plane systolic excursion (TAPSE). Three-dimensional echocardiography was used for right ventricular volumes, ejection fraction and stroke volume evaluation Results: All patients underwent successful and uncomplicated surgery. Preoperative right ventricular function was normal in all patients. Groups failed to statistically differ in basal right ventricular volumes and function and cross-clamping time. A postoperative TAPSE fall was found in both groups, but mini-invasive patients experienced a statistically significant less marked variation (22.2�4.1 post versus 23.5�3.4 pre, p=0.06) versus traditional surgery (15.2�3.1 post versus 25.8�5.2 pre, p