We reviewed our experience of tricuspid valve surgery for tricuspid regurgitation in hypoplastic left heart syndrome (HLHS) in terms of surgical timing, surgical procedures and long-term results. From May 1991 to July 2010, 105 classic HLHS patients underwent cardiac surgery, 28 of whom underwent a total of 31 tricuspid valve surgical procedures. Tricuspid valve surgery was performed in cases of moderate or more tricuspid regurgitation (TR). Type of the first tricuspid valve surgery was as follows : Annuloplasty in 15 patients, annuloplasty+commissure closure in 7 patients, commissure closure in 2 patients, edge-to-edge repair in 2 patients, tricuspid valve replacement in 2 patients. Three patients underwent re-operation because of progression of TR. Two of them underwent tricuspid valve repair and one of them underwent tricuspid valve replacement. Follow-up was 60.1±53.0 months. Freedom from moderate or more TR after tricuspid valve surgery was 50.9% at 1 year, 42.0% at 3 years, 36.0% at 5 years. Among 17 patients who achieved total cavopulmonary connection procedure, 35.2% of patients had moderate or more TR, but central venous pressure (9.1±2.2 mmHg), cardiac index (3.5±6.8 l/min/m²), arterial oxygen saturation (94.2±1.7%) showed as good hemodynamics after a Fontan procedure as non-tricuspid valve surgery cases. Appropriately timed aggressive tricuspid valve surgery yielded as good long-term results as HLHS without tricuspid valve surgery.

A 44-year-old man was given a diagnosis of severe ischemic heart disease and Leriche's syndrome. He had critical ischemia in the lower extremities and ischemic gangrene in a toe of the left foot. We planned a one-stage operation for these fatal diseases. To prevent irreversible ischemia of the lower limbs after mobilization of internal thoracic arteries or during extracorporeal circulation, we performed aorto-ilio femoral bypass grafting with extra-peritoneal approach first. Then conventional coronary artery bypass grafting was carried out for three coronary arteries with bilateral internal thoracic arteries (ITAs) and the saphenous vein. The postoperative course was uneventful.