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.

Between February 1999 and November 1999, 33 patients (age 67.0±7.6 years old) underwent off-pump CABG using coronary shunt tubes. The number of graft anastomoses per patient was 2.8±0.8. The operative mortality was 0%. There was no incidence of on-pump conversion, low cardiac output syndrome, IABP insertion, mediastinitis or stroke. The maximum CPK-MB during the perioperative period was 25.9±18.8IU/l. One patient had perioperative myocardial infarction probably due to native coronary artery spasm. In patients with off-pump CABG, the intubation time, the ICU stay and the hospital stay were shorter. The number of patients who were extubated in the operating room was higher and the cost was lower than those with on-pump CABG. An early phase study revealed patency ratios of 85% (the previous term) and 97% (the latter term). Off-pump CABG is a safe and effective means of revascularization with no mortality, minimal morbidity and good short-term patency.

A 2-month-old boy developed Methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis after bidirectional Glenn anastomosis for hypoplastic left heart syndrome. After reexploration, only the skin was closed but the sternum left open, and continuous mediastinal irrigation using saline containing isodine was commenced at an infusion rate of 20-40ml/h. The sternum was closed on day 7 and irrigation was stopped on day 21. The patient was weaned from the ventilator 4 days later, and is currently in a good condition awaiting a Fontan operation.