It is well known that dialysis-dependent renal failure increases the likelihood of a poor outcome following cardiac surgery. However, it is not known whether non-dialysis-dependent mild renal insufficiency also influences clinical outcome. Fifty-five patients with non-dialysis-dependent renal insufficiency undergoing coronary artery bypass grafting (CABG) (Renal group: serum creatinine level >1.5 mg/dl) were enrolled. These patients were then matched on prognostic variables to 148 patients with normal renal function (Control group: serum creatinine level <1.5 mg/dl). The early postoperative clinical results showed that patients in the Renal group were more likely to develop postoperative renal failure (18% vs 1%; p=0.0002) and hemorrhage requiring re-exploration (11% vs 2%; p=0.01). Total morbidity was significantly higher in the Renal group (40% vs 22%; p=0.01). Multivariate analysis revealed that the Renal group was the second most important predictor of morbidity (odds ratio (OR) =2.2) behind left ventricular dysfunction (OR=2.9). The Renal group was also the second most important predictor of postoperative renal failure (OR=12.5). Therefore, non-dialysis-dependent mild renal insufficiency also increases the risk of morbidity following CABG. (Jpn Circ J 2001; 65: 28 -32)

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eft ventricular (LV) rupture is one of the most severe complications after mitral valve replacement (MVR). Although its occurrence is rare, it is potentially lethal. The present report describes successful repair of a type 1 LV rupture, which occurred after MVR concomitant with a left atrial (LA) reduction procedure, by combination of an intracardiac patch repair and an extracardiac buttress suture. Case ReportA 64-year-old woman, who was diagnosed with mitral stenosis with atrial fibrillation resulting from rheumatic fever, underwent percutaneous mitral comissurotomy. After this procedure, severe mitral regurgitation occurred. The patient subsequently underwent mitral replacement and LA reduction in May 1999.The operation was performed with a cardiopulmonary bypass and intermittent/continuous cold blood cardioplegia. The atrial incision was initiated from the right side of the LA, and an area of the pulmonary vein was circularly isolated. The middle third of the LA, including the LA appendage, was excised, as followed by a report by Sankar and Farnsworth. 1 The mitral valve was found to have developed fibrosis of the leaflet, and chordae shortening without calcification. There was a tear measuring 2 cm on the anterior leaflet, which was created by the percutaneous mitral comissurotomy. Both the anterior and the posterior leaflet were excised. The 27 mm ATS mitral prosthesis is fixed to the mitral annulas using interrupted mattress sutures. Japanese Circulation Journal Vol.65, June 2001After weaning from the cardiopulmonary bypass, a major bleeding was suddenly noted from the posterior area of the heart during the hemostasis of the LA suture line. Simultaneously, the ST level was elevated on the II and V5 leads of the electrocardiogram. Because LV rupture was suspected, cardiopulmonary bypass was re-established immediately. Epicardial oozing and myocardial hematoma were recognized at the posterior left ventricular wall, but the Rupture of the posterior wall of the left ventricle after mitral valve replacement is a dire complication associated with a very high mortality. This study reports a successful repair of type 1 left ventricular rupture, which occurred after mitral valve replacement concomitant with a left atrial reduction procedure, by combination of an intracardiac patch and an extracardiac buttress suture. In a case such as this, in which hemostasis is quite difficult to establish, this combination technique is particularly effective. ( Full-thickness buttressed suture was placed on the epicardium while making an effort to avoiding circumflex artery injury. Additionally, fibrin glue/sheet and GRF glue on the Teflon sheet were used to enhance hemostasis.

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Shprintzen-Goldberg syndrome (SGS) is a rare disorder with many characteristics of generalized connective tissue dysplasia. SGS is characterized by Marfanoid habitus with craniosynostosis and mental retardation. Patients with SGS have cardiovascular disorders similar to Marfan syndrome (MFS) and those disorders seem to play an important role in the prognosis of SGS. To our knowledge, only 19 patients with SGS have been reported, and 7 of them had cardiovascular disorders. The major cardiovascular disorders of SGS are aortic root dilatation and mitral valve prolapse. We reported the first case of SGS successfully treated surgically for cardiovascular disorders. Since then, we performed another operation in a patient with SGS. In this paper, we report our surgical results in patients with SGS.

ecause the outcome of tricuspid valve replacement (TVR) is relatively poor, most tricuspid valve surgery is repair procedures. As a result, the experience of prosthetic valve replacement in the tricuspid position is limited and the optimal choice of replacement valve is still controversial. Generally, bioprostheses have excellent antithrombogenic characteristics with relatively greater durability, and many recommend this choice for TVR. 1-3 On the other hand, satisfactory results with the newly developed bileaflet mechanical valve have been demonstrated, 4-7 though higher levels of anticoagulation were required. In particular, when a patient already has mechanical prostheses in the aortic and/or mitral position, a more durable mechanical valve may be a better choice than a bioprosthesis, because such patients will require anticoagulation regardless of the kind of prosthesis used in the tricuspid position. Additionally, the patient often has had multiple previous valve surgeries, so any future potential surgery should be avoided because of the high surgical risk.The mechanical bileaflet valve was our first choice for the tricuspid position in patients undergoing triple valve replacement (aortic, mitral and tricuspid positions). Here we review our experience of triple valve replacement with mechanical valves and assess the optimal valve selection, particularly for the tricuspid position.