In this paper, we describe a rare case of a giant aneurysm of the circumflex artery that we managed. A 59-year-old female patient presented in cardiogenic shock after partial aneurysm rupture. Giant aneurysms of the circumflex artery are extremely rare entities. The optimal surgical management dictates meticulous preoperative planning and the operation should be carried out on an elective basis.

A 70-year old patient with chronic atrial fibrillation, a large atrial septal defect (ASD) and severe tricuspid regurgitation of rheumatic aetiology was admitted to our unit for elective surgery, through a mini right thoracotomy (RT).

Background Fractional flow reserve (FFR) is a well-established method for the evaluation of coronary artery stenosis before PCI. However, whether FFR assessment should be routinely used before CABG remains unclear. Our aim was to compare the outcomes of using FFR with that of conventional CAG (coronary angiography) in guiding CABG. Method This systematic review and meta-analysis was performed according to the PRISMA guidelines. Six studies were included, of which four were double-arm (two prospectively randomised) and two single-arm, reporting data on 1931 patients. A meta-analysis was done for double-arm studies, comparing rates of overall death, MACCE, target vessel revascularisation, spontaneous MI and graft patency. The data of all six studies were entered in a pooled analysis for the endpoints of overall death, spontaneous MI and target vessel revascularisation. Results Meta-analysis demonstrated significantly lower death rates in the FFR-guided than the CAG-guided group (p=0.03) and no significant differences in the rates of MACCE, target vessel revascularisation, spontaneous MI and graft patency. In pooled analysis, FFR-guided group was linked with lower rates of overall death and spontaneous MI. Graft occlusion rate was significantly lower after FFR in one retrospective study, however, this difference was lost in meta-analysis (p=0.24). Conclusion In this meta-analysis, FFR-guided CABG was associated with lower overall death rate and was, at least, non-inferior in the endpoints of MACCE, target vessel revascularisation, spontaneous MI and graft patency than CAG-guided CABG. Further randomized trials are needed to define the role of FFR in guiding CABG surgery.

Although porcine mitral bioprostheses provide predictably good long-term outcomes, unexpected leaflet tears leading to abrupt haemodynamic changes may occur. We report on a patient who presented with acute dyspnea due to cuspal tear of a porcine bioprosthetic mitral valve causing severe mitral regurgitation, her condition was subsequently complicated by systemic infection, probably pneumonia, and was successfully managed with urgent redo-mitral valve replacement.

Background and Aim Endoscopic radial artery (RA) harvest (ERAH) is an alternative to open RA harvest (ORAH) technique. Our aim was to compare clinical outcome, patent satisfaction and 1-year angiographic patency rates after ERAH and ORAH. Patients and methods 50 patients undergoing multivessel CABG were prospectively randomized to two groups. In the ERAH group (25 patients) the RA was harvested endoscopically and in the ORAH group (25 patients) openly. Results There were not differences between the groups in preoperative characteristics. Length of skin incision was shorter in ERAH (p<0.001) but there were not differences in the length of RA, harvest time, blood flow and pulsatility index after ERAH and ORAH. Wound healing was uniformly smooth in ERAH and there were 2 haematomas and 1 infection in ORAH. Postoperatively, major neuralgias were present in 5 patients in ORAH and none in ERAH (p=0.05) and minor neuralgias in 11 and 3 patients (p=0.02) respectively. Twenty-four patients in ERAH and 4 in ORAH graded their experience as excellent (p<00001). One-year angiographic RA patency was 90% without intergroup difference. Target vessel stenosis < 90% adversely affected RA patency (p<0.0001). Conclusions In expert center, ERAH has no negative impact on time harvest, length and quality of RA conduit. Moreover, ERAH may provide better wound healing, and is associated with less neuralgias, excellent cosmetic result and better patient satisfaction. RA graft patency is unaffected by the harvesting technique and is excellent when placed to a target coronary artery vessel with stenosis > 90%.