We had the opportunity to use a bidirectional Glenn shunt (BDG) as a therapeutic aid in an urgent operation of active tricuspid valve endocarditis in an adult case with the tetralogy of Fallot. The patient was a 44-year-old man with untreated tetralogy of Fallot. He noticed progressing dyspnea on exertion and chest discomfort a few years previously. He had suffered from fever and cough during these several months. At last he was admitted to our Center on an emergency basis due to persistent high fever. Echocardiography revealed large vegetation on the tricuspid valve along with positive blood culture of Streptococcus. Antibiotic therapy was started, but septic lung embolism forced us to perform an urgent operation. To avoid using an artificial valve or leaving free tricuspid regurgitation with tricuspid valve excision, we repaired the tricuspid valve using fresh autologous pericardium and DeVega annuloplasty. Since we left stenosis at tricuspid valve, we added the BDG to minimize the volume load on the repaired tricuspid valve. It worked well and the patient successfully was weaned from CPB. Despite the initial postoperative course related to the lung abscess from the infected embolism, the patient is doing well at home 12 months after the surgery. This strategy using BDG is one modalilty to cope with this formidable situation.

This study was designed to evaluate the optimal surgical treatment strategy for abdominal aortic aneurysm (AAA) coexisting with coronary artery disease (CAD). Twenty-six patients (21 men and 5 women with a mean age of 72.6±3.7 years old) who required surgical treatment of both conditions were examined. Eleven patients underwent a one-stage operation. Four of them had on-pump CABG and 7, including 3 high-risk-patients, underwent off-pump CABG. There were no operative mortalities, but 3 patients had severe morbidity (respiratory failure, acute renal failure, pneumonia). Fifteen patients underwent a two-stage operation. None of them had rupture of the AAA during the interval between the two operations, but 2 patients with large AAA (more than 6cm in diameter) required emergency operation due to impending rupture of the AAA. There was no operative mortality, but one patient suffered acute renal failure. One-stage operation for low-risk patients seems to be a safe and reasonable strategy. One-stage operation for high-risk patients should be performed cautiously, and off-pump CABG is especially useful in such patients.