There are some recent reports on the effect of posterior pericardiotomy to the postoperative supraventricular tachyarrythmias (SVT). Although controversy still exists on its effect on atrial fibrillation, its clinical benefit on pericardial tamponade is satisfactory [1±3]. To test its effectiveness on SVT we started performing posterior pericardiotomy where we experienced an unusual case on the 29th patient.

A 55 year old man with left main coronary stenosis besides two vessel disease, normal ventriculography and ejection fraction 65% was operated in standard fashion with a roller pump, non-pulsatil flow (2.0±2.4 l/min), Polystanw membrane oxygenator, 328C systemic hypothermia, single cross clamp, initial antegrade 1 retrograde cold blood cardioplegia, repeated cold retrograde blood cardioplegia every 20 min, and a hot shut before the removal of the cross clamp. LIMA grafting to the LAD and sequantial saphenous graft to first diagonal, intermediate and obtuse marginal arteries were performed. After an uneventful operation (£ clamp time 42 min, total perfusion time 58 min) the patient was placed in the ICU ward where the patient deteriorated with lateral ST elevation and multifocal ventricular arrhythmias, which did not respond to the medical therapy, continued with ventricular fibrillation (VF), which also did not respond to defibrillation. The patient returned to the operating room urgently and re-explored. After reopening the sternum VF had been over come following the first defibrillation with internal paddles. The hemodynamia returned to normal in a short time with positive inotrops followed by ST normalisation. All the bypass grafts were patent, nothing unusual was observed. Following haemostasis sternum was wired again. But by the time of cutaneous sutures, the ST elevation relapsed, the hemodynamia failed quickly, VF re-occurred. The sternum was reopened in a short time and the heart was