A 26-year-old female practising Jehovah's witness presented with a history of recurrent respiratory infections since childhood and more recently, recurrent cardiac dysrhythmias. A large bronchogenic cyst arising beneath the carina and compressing the bronchi was felt to be responsible. The cyst was adherent to the roof of the left atrium. She initially underwent a partial excision through the standard approach of left thoracotomy. Complete resection via this route was hazardous with real danger of laceration of the atrial wall. Repeat surgery was performed on cardiopulmonary bypass 3 years later for recurrence of symptoms. Complete excision was achieved.