Unusual presentation of arteria lusoria along with ascending aortic aneurysm.

Arteria lusoria (AL) is a rare embryological variant that may have variable presentation ranging from asymptomatic to respiratory, abdominal, or both. Increasing incidence of radial access for coronary angiogram may lead to the incidental diagnosis of AL. Knowledge about this anatomical variation is essential for cardiologists, interventional radiologists, otorhinolaryngologists, cardiothoracic surgeons, and primary physicians. The symptomatic patient should undergo definite repair through either surgery or endovascular techniques. We present a case of incidentally diagnosed, asymptomatic AL along with ascending aortic aneurysm while evaluating for ischemic heart disease.

Pandemic created clinical eclipse: hemosiderosis versus COVID-19 pneumonia.

In the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, the physician finds difficulty in differentiating the symptoms due to cardiac disease from that of SARS-CoV-2. We would like to present one such mystified situation (hemosiderosis versus SARS-CoV-2 pneumonia) we encountered.

Double cobra head technique of distal coronary anastomosis.

In 1967, Dr. René Favaloro introduced the use of reversed greater saphenous vein graft for coronary artery bypass grafting, since then a lot of efforts were made to improve the venous graft patency rate. We introduce a novel double cobra head technique of distal coronary anastomosis for better distal runoff. We expect our technique will help in difficult situations such as limited conduit availability and target vessel with bifurcation lesions. Refining our surgical techniques is essential to keep ourselves well equipped to compete with the rapidly evolving stent culture.

Technical Aspects: Coronary Artery Bypass Grafting in a Case of Dextrocardia With Situs Inversus.

Dextrocardia with situs inversus is a rare congenital anomaly in which the heart and the abdominal organs orient themselves in a mirror-image reversal of the normal anatomy. Coronary artery disease incidence is similar to that of the normal population. Performing coronary artery bypass grafting in this subset of the population poses few difficulties. These limitations can be overcome by few technical adjustments by the surgeon and the team which will be discussed in our article.

Uncommon Anatomic Variation of Left Internal Mammary Artery: God-Created Y-Graft Conduit.

The left internal mammary artery is the most accepted and widely used conduit in coronary artery bypass grafting. This report presents a rare case of very early bifurcation of the left internal mammary artery at the level of the third intercostal space.

Primary Closure of a Partial Superior Sternal Cleft in a 27-day-old Neonate: Case Report with Short Review of Literature.

A sternal cleft is a chest wall malformation resulting from a failure of sternal fusion. It is a rare anomaly with an incidence of 2:100,000 live births representing less than a percent of all chest wall deformities. The aim of surgery is to provide bony protection over the mediastinal structures. We present a 27-day-old neonate with an upper partial sternal cleft for whom successful primary sternal closure was performed.

Reversed Elephant Trunk Technique for the Repair of Type B Aortic Dissection: A Case Report.

We report a case of a type B aortic dissection with an aneurysm treated by the replacement of the proximal descending thoracic aorta via the reversed elephant trunk technique. A 48-year-old asymptomatic man was diagnosed with a type B aortic dissection, moderate aortic regurgitation, and a good biventricular function in March 2012. Four years later (April 2016), a contrast-enhanced computed tomography examination revealed an aneurysmal dilatation in the patient's descending thoracic aorta with a thrombosis in the proximal part of the false lumen, which warranted surgical repair. He underwent type B aortic dissection repair through the left posterolateral thoracotomy. Three months after the surgery, the patient developed a type A aortic dissection with severe aortic regurgitation, which was successfully managed via a Bentall procedure with arch replacement facilitated by the reversed elephant trunk technique performed during the initial surgery through thoracotomy. At 2 years follow-up, the patient was doing well with a normal left ventricular function.

Role of surgical ventricular restoration post surgical treatment of heart failure (STICH) trial.

OBJECTIVE: To compare the outcomes of isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) with or without CABG for patients with ischemic cardiomyopathy (ICM). METHODS: Retrospectively, 49 patients with ICM and severe LV dysfunction (LVEF < 35%) who underwent SVR with or without CABG from January 2009 to December 2016 at a single institution was compared with 49 patients who underwent isolated CABG. The two groups were matched for preoperative clinical and echocardiographic parameters including left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV). Primary outcomes analyzed included early mortality, late mortality, and major adverse cardiac or cerebrovascular events (MACCE). Secondary outcomes analyzed included echocardiographic parameters of left ventricular volume and function-indexed left ventricular end-diastolic volume (LVEDVi), indexed left ventricular end-systolic volume (LVESVi), and LVEF. Cox and survival analysis was performed. RESULTS: Early and late mortality in SVR vs. CABG groups were 4 (8.1%) and 6 (12.2%) vs. 1 (2%) and 5 (10.2%) respectively. Mean improvement in LVEF was 3.39 ± 7.51 compared to 4.97 ± 5.45 between the two groups at 3-month follow-up. Mean improvement in LVEF was 5.1 ± 8.3 in the SVR group vs 5.9 ± 7.1 in the CABG group at the last follow-up. There was no statistically significant improvement between the two groups in terms of LVEF at 3 months or the last follow-up. There were statistically significant differences between LVEDVi and LVESVi between the two groups at 3 months and the last follow-up. The 5-year rates of survival were 85 ± 6 and 82 ± 9% for SVR and CABG groups respectively. The 5-year rates of freedom from MACCE were 75 ± 7 and 60 ± 11% for SVR and CABG groups respectively. CONCLUSION: Compared with isolated CABG, SVR plus CABG results in equivalent late mortality and better left ventricular reverse remodeling (as evidenced by LV volume reduction) and better freedom from MACCE at 5-year follow-up.