A 67-year-old man was admitted with heart failure. He had a past history of closed chest trauma due to a traffic accident at the age of 24. He had been complaining of a gradual increase of fatigue since a few years after the accident and received medical treatment. At approximately 40 years of age, he underwent cardiac catheterization and was given a diagnosis of Ebstein malformation. However surgery was not recommended. An echocardiogram showed a laceration at the tricuspid valve, enlargement of the tricuspid valve annulus and severe tricuspid regurgitation. The displacement of tricuspid valve was not present. His case was complicated with severe liver dysfunction of Child-Pugh class B and Model for End-Stage Liver Disease score 15. We performed tricuspid valve replacement with a Mosaic 31 mm tissue valve. The patient required pleurodesis for refractory severe pleural effusion at 2-months and was discharged 6 months after the operation.

Persistent massive air leak after pediatric cardiac surgery is a rare and possibly life-threatening complication which is difficult to treat. We report a 3-month-old boy with hypoplastic left heart syndrome that underwent Glenn take-down, suffered from pulmonary hemorrhage during surgery and needed mechanical ventilation with high airway pressure that caused bilateral pneumothorax. After pulmonary hemorrhage improved, pneumothorax with persistent air leaks did not resolve under prolonged chest tubes. This patient underwent an autologous “blood patch” pleurodesis on postoperative day 32. The procedure was repeated a second time 48 h after the application of the first blood patch. After these procedures, air leaks dramatically ceased. The patient was successfully weaned from the ventilator on postoperative day 70. Pleurodesis with an autologous blood patch is a safe and an effective technique for the treatment of persistent air leaks, even for a 3-month-old boy with hypoplastic left heart syndrome.

There are no clear guidelines on thromboprophylaxis in patients following Fontan surgery. In addition, most reports on thromboprophylaxis refer to systemic thromboembolism. Therefore, there are few reports on thromboprophylaxis for extracardiac conduits. We experienced a case of thrombus in extracardiac conduit leading to liver damage after the Fontan completion. The patient was an 11-year-old girl, who underwent the Fontan procedure at 3 years of age. She was on aspirin for thromboprophylaxis. Eight years postoperatively, cardiac catheterization demonstrated severe conduit stenosis, and chronic liver damage was seen at that time. The patient successfully underwent conduit replacement. Subsequently, ascites disappeared and platelet count improved. Conduit stenosis after Fontan completion is a rare but serious complication, therefore we should always keep it in mind and aspire to early detection.

Bleeding control during aortic surgery is one of the most important issue. The well-known fibrinogen-based hemostat contains the blood product, which means the potential risk of the blood-related infection. Recently, the newly-designed hemostat “Hydrofit”, which is assembled with urethane-based polymer without blood product (Matsudyte : Sanyo-chemical industry, Kyoto, Japan). Hydrofit is applicated for the hemostasis of thoracic aortic surgery. In sealing of the Hydrofit gel to the anastomosis site of aorta, water-contact initiation boosts the chemical change to the forming elastomer and adheres around anastomosis site rapidly. We experienced the extirpation of the Hydrofit which was used over 4 years ago. The patient is 42 year-old female who was operated aortic valve replacement and graft replacement of ascending aorta using a Hydrofit as a hemostat at 4 year 8 months ago due to the aortitis syndrome. Re-sternotomy and re-AVR was performed because of the prosthetic valve dehiscence due to the active aortitis syndrome. Hydrofit left around suture line without infection, and functioned very well as the elastic sealant for the long-term period.