Human heart fatty acid-binding protein (HH-FABP), which is a low molecular weight protein and abundant in the cytoplasm of myocardial cells, is reported to be released into the circulation shortly after the onset of acute myocardial damage. However, the changes in serum HH-FABP levels in open heart surgery have not been elucidated. To determine whether HH-FABP enables the earlier detection of myocardial damage caused by ischemia-reperfusion in open heart surgery, we measured the serial levels of serum HH-FABP, CK-MB and Troponin T (TnT) at every 15 min for 48 hours after reperfusion in 10 adult patients with coronary artery bypass graft. The serum HH-FABP levels reached the peak within 60 min after reperfusion (mean +/- SD; 49 +/- 7 min), and this was significantly (p < 0.001) earlier than CK-MB (212 +/- 108 min) and TnT (244 +/- 150 min). The peak value of serum HH-FABP had a significant correlation to the peak value of serum CK-MB or TnT (r = 0.815, p = 0.02; r = 0.925, p = 0.0001, respectively). These results indicate that serum HH-FABP enables the earlier detection of myocardial damage than the other markers in the patients with open heart surgery.