(1) Background: Disparity in clinical care on the basis of gender, socioeconomic status, ethnic and racial variation is an established phenomenon. The focus on health disparities was led on by the report of the Secretary’s Task Force on Black & Minority Health, which emphasized that the burden of death and illness was in excess among black people and other minorities. In Saudi Arabia, cardiac health care is being provided to a heterogeneous group of patients during pilgrimage time. This mixed population comprises different socio-economic backgrounds, demographics, ethnicities and languages. This study was carried out to assess for any disparities in cardiac surgical outcomes after isolated CABG surgery between Saudi citizens and non-Saudi patients. (2) Methods: The data of 2178 patients who underwent isolated coronary artery bypass surgery at King Abdullah Medical City from December 2014 to July 2020 were extracted. Patient demographics, clinical features, comorbidities, diagnoses, surgical procedures, complications, length of hospital stay and mortality were included in the data. The primary outcome was mortality after coronary artery bypass grafting surgery. (3) Results: A total of 2178 isolated CABG procedures were conducted during the study period with almost 57.5% of patients being Saudi citizens in comparison with 42.5% of non-Saudi citizens. The male gender represented the majority of the population, with a total of 1584 patients, representing 72.7% of the total study population. The rate of mortality had no statistical significance with the mortality rate of 5% vs. 5.3% (p < 0.786). The postoperative morbidities were comparable for all the parameters except for postoperative extracorporeal membrane oxygenation (ECMO). (4) Conclusions: In the present study, the chances of survival and postoperative outcomes are not associated with nationality per se, but with underlying comorbidities.

BACKGROUND Coronary artery anomalies (CAAs) are rare congenital conditions, with an incidence of approximately 0.01-0.03%. While often asymptomatic and discovered incidentally, certain variants carry serious prognostic implications. Among these, an anomalous left anterior descending (LAD) artery arising from the right coronary artery (RCA) with an inter-arterial course between the aorta and pulmonary artery is considered malignant due to its association with myocardial ischemia and sudden cardiac death, particularly in young adults. Early recognition and tailored management are therefore essential. CASE REPORT We describe the case of a 37-year-old man with a background of dyslipidemia, heavy smoking, and illicit drug use who presented with recurrent chest pain and suspected acute coronary syndrome. Electrocardiography revealed anteroseptal ST-segment elevation, although initial troponin was negative. Coronary angiography demonstrated an anomalous LAD originating from the RCA, with myocardial bridging at the mid-segment. Computed tomography coronary angiography confirmed a malignant inter-arterial course. A submaximal stress SPECT perfusion study achieved 77% of target heart rate, reproducing chest pain and revealing a small, reversible perfusion defect in the anteroseptal wall, consistent with ischemia. Despite optimal medical therapy, the symptoms persisted. He underwent on-pump coronary artery bypass grafting (CABG), and his postoperative recovery was uneventful. CONCLUSIONS An anomalous LAD with a malignant course is a potentially life-threatening condition. Multimodality imaging, functional assessment, and definitive surgical revascularization are critical to preventing adverse outcomes. This case highlights the importance of considering coronary anomalies in patients with unexplained or recurrent chest pain.

Background: Right ventricular outflow tract (RVOT) reconstruction is frequently performed for pediatric patients with pulmonary valve anomalies, yet optimal techniques remain debated. The equine pericardium offers a promising substrate for pulmonary valve reconstruction but has been understudied in pulmonary valve reconstruction. This study evaluated a novel technique using the equine pericardium to create a cylinder bicuspid pulmonary valve for RVOT reconstruction. Methods: In this retrospective cohort study, 17 pediatric patients (median age: 10 months; 53% male) underwent RVOT reconstruction with equine pericardium between 2023 and 2024. The valve was fashioned from a patch of equine pericardium into a cylinder to create a functionally bicuspid valve. The height of the cylinder ranged from 1.5–2 cm. The diameter was measured around a Hegar dilator corresponding to a valve size z-score of +3. The outcomes included the degree of postoperative pulmonary regurgitation, RVOT pressure gradients, postoperative complications, and reinterventions. Results: Postoperatively, the median peak RVOT pressure gradient decreased significantly from 70 mmHg (IQR: 65–90) to 25 mmHg (IQR: 20–40; p < 0.001). Mild pulmonary regurgitation persisted in one patient (5.9%). Five patients had mild right ventricular dysfunction (29.41%). At a median 3-month follow-up (IQR: 1–8), 17.7% (n = 3) underwent cardiac catheterization. There was no postoperative mortality. Conclusions: Cylinder bicuspid pulmonary valve reconstruction using the equine pericardium effectively reduces RVOT obstruction while maintaining pulmonary valve competence and demonstrates acceptable short-term safety. Having a competent pulmonary valve after repairing the hypoplastic pulmonary valve annulus is very promising; however, the small cohort and limited follow-up preclude definitive conclusions about long-term durability. Larger prospective studies with longer follow-up periods are needed to validate this technique for RVOT reconstruction.

BACKGROUND Pseudoaneurysms of the sinus of Valsalva (SOV) are rare and potentially life-threatening. Simultaneous pseudoaneurysms involving multiple sinuses and the ascending aorta are extremely uncommon. These lesions can exert a mass effect on adjacent cardiac structures, leading to valve dysfunction and heart failure. CASE REPORT We present the case of a 35-year-old man who was referred with progressive dyspnea and signs of heart failure. Although a prior febrile illness raised suspicion for an infectious etiology, the definitive cause remained indeterminate due to negative microbiological and serological workup. Initial imaging suggested an aortic dissection; however, further evaluation revealed large pseudoaneurysms in the left and right sinuses of Valsalva and the ascending aorta. Severe mitral regurgitation was noted, attributed to extrinsic annular distortion from the large left SOV pseudoaneurysm. The patient underwent urgent surgical intervention, including closure of the left and right SOV pseudoaneurysm orifices with bovine pericardial patches, excision of the ascending aortic pseudoaneurysm, and mitral valve annuloplasty using a 30-mm Carpentier-Edwards Physio II ring. The aorta was reconstructed without the need for a prosthetic graft. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 10. CONCLUSIONS This case illustrates a rare constellation of multiple SOV pseudoaneurysms. Crucially, it highlights the mechanistic link between the pseudoaneurysm's mass effect and functional mitral regurgitation. Timely surgical management corrected the anatomical defects and restored hemodynamic function. Awareness of such unusual presentations is essential for accurate diagnosis and prompt intervention.