Open heart surgery in patients with liver cirrhosis is considered to be very risky, but the predictors of poor outcomes in such cases have not been established. We report the perioperative results of open heart surgery in patients with liver cirrhosis in our hospital. We reviewed the results of 13 cases in 12 patients with liver cirrhosis who underwent open heart surgery between January 2001 and December 2010. The Child-Turcotte-Pugh classification, the model for end-stage liver disease score, EuroSCORE, and perioperative data were used to identify risk factors for morbidity and mortality retrospectively. Ten patients had postoperative complications. Significant differences in morbidity were evident for Child-Turcotte-Pugh class, cardiopulmonary bypass time, and crossclamp time. Two patients died of liver failure, one at 40 days and the other at 2 years after surgery. Statistically significant differences in liver-related mortality were evident in the model for end-stage liver disease scores and serum cholinesterase levels. We concluded that a high Child-Turcotte-Pugh class was associated with increased morbidity. Cardiopulmonary bypass and crossclamp times were also related to high morbidity, while high model for end-stage liver disease scores and low serum cholinesterase levels predicted liver-related mortality.

We herein report the case of a normal 63-year-old woman whose initial clinical symptom was a continuous fever above 38 degrees Celsius. Upon admission, a physical examination revealed a continuous heart murmur that was audible at the 2nd intercostals space along the left sternal border. Chest computed tomography revealed that vegetation was attached to the pulmonary arterial wall near the orifice of the duct (Picture 1, 2). Transesophageal echocardiography showed a continuous jet from the aortic arch to the pulmonary artery (Picture 3). She was therefore diagnosed with infective endocarditis due to patent ductus arteriosus. Her blood cultures revealed the presence of Pseudomonas aeruginosa. Surgical management was necessary due to the uncontrollable infection. A mattress suture was placed quickly in order to close the shunt flow via the pulmonary artery. The patient was transferred to the cardiology department at 13 days postoperatively in satisfactory condition without any critical complications. There have thus far been few reports concerning pulmonary endarteritis associated with silent patent ductus arteriosus (1, 2). The authors state that they have no Conflict of Interest (COI).References 1. Onji K, Matsuura W. Pulmonary endarteritis and subsequent pul-

The efficacy of using composite arterial Y-grafts in off-pump coronary artery bypass has not been established. We assessed graft patency, long-term clinical outcomes, and the indications for composite arterial Y-grafting by reviewing 53 patients who underwent primary isolated elective off-pump coronary artery bypass with composite arterial Y-grafts between January 2002 and December 2008. Coronary angiography or 64-slice multidetector computed tomographic coronary angiography was used to assess graft patency. Follow-up ranged from 18 to 97 months. The rates of mortality, graft failure, and recurrence of ischemic heart disease were 0%, 22.6%, and 13.2%, respectively. Only 4 (7.5%) patients required additional procedures (percutaneous coronary interventions or repeat surgery) because of graft failure. A significantly higher rate of graft failure was evident when one end of the composite graft was anastomosed to a 75% stenosed branch of a native coronary artery and the other end to a branch with >90% stenosis. The long-term patency of composite arterial Y-grafts in off-pump coronary artery bypass requires proper judgment of the indications.

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