Pii: S0003-4975(02)05009-9

attempted with BioGlue surgical adhesive (Cryolife International Inc, Kenesaw, GA), which is a polymer of bovine serum albumin and glutaraldehyde that reaches bonding strength within 2 minutes of mixing and application. The patient was placed back onto bypass and cooled, and the heart was perfused with cardioplegic solution. BioGlue was then applied to the external surface of the dehisced margins of the atrioventricular groove, and a patch of bovine pericardium was placed over the glue before it set, with a total circulatory arrest time of 2 minutes to ensure a dry field. The circulation was then restarted, but further bleeding complicated attempted weaning from cardiopulmonary bypass. Therefore, the pericardium was removed, and 2-0 Ticron polytetrafluoroethylene (Teflon) -bolstered sutures were used to attempt to close the defect. However, the sutures themselves caused additional bleeding from the damaged tissues. Consequently, a further attempt to achieve hemostasis with the BioGlue surgical adhesive was performed with the heart arrested and perfused with cardioplegic solution again. The BioGlue was applied under and over the Teflonpledgeted sutures, and another patch of Teflon felt was glued on top of the Teflon-pledgeted sutures. It was held firmly in place for 2 minutes to achieve good adhesion, and then the aortic cross-clamp was released. Fortunately this second attempt resulted in a dry operative field with complete control of the bleeding. The patient spontaneously went into sinus rhythm after the cross-clamp was released, and bypass was withdrawn without inotropic support. The patient was deliberately kept hypotensive overnight with a mean blood pressure less than 70 mm Hg. She then made an uneventful recovery. Before discharge an echocardiograph showed no perivalvular leak from either the mitral or aortic valve.