Anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital coronary anomaly with an estimated incidence of 1 in 300,000 live births. While commonly diagnosed in infancy, adult presentations are exceedingly rare and pose significant diagnostic challenges. Delayed diagnosis may result in progressive myocardial ischemia, heart failure, arrhythmias, or sudden cardiac death. Surgical correction is the definitive treatment, with the goal of restoring a dual coronary artery system and preventing irreversible myocardial damage. We present the case of a 30-year-old male with a prior history of non–ST-elevation myocardial infarction who was referred for evaluation of exertional angina and symptoms of heart failure. Transthoracic echocardiography revealed a dilated left ventricle with an ejection fraction (LVEF) of 35%. Coronary angiography and cardiac MDCT identified an anomalous origin of the left circumflex artery (LCx) from the right pulmonary artery (RPA) and a coronary–pulmonary artery fistula involving the LAD. The patient underwent successful surgical correction with reimplantation of the LCx into the ascending aorta. Postoperative recovery was uneventful. At 3-month follow-up the patient was symptom-free, though echocardiography revealed persistent LV dilation and reduced LVEF, necessitating continued pharmacologic therapy and monitoring. This case highlights the importance of maintaining a high index of suspicion for ALCAPA in adult patients with unexplained cardiomyopathy or ischemic symptoms. Early diagnosis and surgical intervention remain crucial for improving long-term outcomes and preventing life-threatening complications.

Background and Objectives: Atrial fibrillation (AF), a prevalent cardiac arrhythmia, significantly impacts the quality of life of those affected. The preferred treatment for symptomatic AF, particularly when pharmacological methods fall short, is catheter ablation with pulmonary vein isolation (PVI). While common pulmonary vein (PV) anatomical variants, such as the right accessory pulmonary vein and the common ostium of left pulmonary veins (LCPV), have been studied extensively, their impact on the long-term outcome of PVI is known to be minimal. However, data on less common anomalies, like the common ostium of the left and right inferior pulmonary vein (CIPV), remain scarce in the medical literature. This report aims to shed light on the challenges and outcomes of catheter ablation in a patient with a rare CIPV anomaly. By presenting this case, we contribute to the limited knowledge about the management of such unique anatomical variations in AF treatment and discuss the importance of individualized treatment approaches. Case Presentation: We present a case involving a 56-year-old male diagnosed with AF in 2018. Initial PVI treatment was successful, but the patient experienced symptom recurrence after three years. A preprocedural CT scan before the second ablation revealed a CIPV anomaly. During the repeat procedure, a right superior pulmonary vein (RSPV) reisolation was performed due to identified gaps in the previous ablation line. Post-procedure, the patient maintained a sinus rhythm and reported no further symptoms. Conclusions: This case highlights the importance of recognizing rare PV anatomies like CIPV in the effective management of AF. Tailored ablation strategies, accounting for unique anatomical conditions, can lead to successful long-term outcomes, reinforcing the need for personalized approaches in AF treatment, especially in cases involving complex anatomical variations.

Coronary artery fistulas (CAFs) are rare congenital anomalies, presenting in 0.05–0.9% of cases, characterized by an aberrant connection between a coronary artery and a cardiac chamber or great vessel. Clinical manifestations can include heart failure, myocardial ischemia due to coronary steal, arrhythmias, or infective endocarditis. We report a case of a 39-year-old man initially evaluated in 2016 for peripheral edema and suspected right ventricular (RV) abnormality. Earlier assessments indicated a left anterior descending (LAD) coronary artery–RV fistula, but initial catheterization was nondiagnostic. Transthoracic echocardiography (TTE) revealed a dilated left coronary artery (LCA) and an RV apex aneurysm, confirmed by CT and coronary angiography, showing a 14 mm LAD fistula with large aneurysmal sacs (45.6 × 37.3 mm). Cardiac MRI demonstrated a tortuous LAD fistula draining into RV aneurysmal sacs with preserved biventricular function. Surgical intervention was recommended, but the patient declined and was lost to follow-up until 2022, being asymptomatic. Re-evaluation showed progression in aneurysm size (47 × 45 mm and 16 × 18 mm) without ventricular functional change. Follow-up TTE in 2023 indicated stable findings. This case emphasizes the necessity of multimodal imaging (TTE, CT, MRI, angiography) for CAF diagnosis and management planning. Given the variability in CAF presentation and outcomes, individualized management—including surgical, percutaneous, or conservative strategies—is crucial. Persistent follow-up is essential for monitoring potential complications and guiding treatment, even in asymptomatic patients refusing intervention.

Background and Objectives: The saphenous vein graft (SVG) remains the most frequently used conduit worldwide, despite its common disadvantage of early graft failure. To solve the problem and reduce the SVG damage, Souza implemented a new technique where a vein is harvested with surrounding fascia and fat tissue (the so-called no-touch technique). Materials and Methods. A prospective study conducted from February 2019 to June 2024 included 23 patients who underwent myocardial revascularization using a no-touch vein, with follow-up control examinations using computed tomographic angiography to detect graft stenosis or occlusion. Results. Of the entire patient group, 17 (73.9%) were male, with a mean age of 67.39 ± 7.71 years. The mean follow-up period was 25 months. There were no major adverse cardiovascular or cerebrovascular events (MACCEs) during hospitalization, although one patient died in the hospital. Another patient died due to malignancy, but no MACCEs occurred during the follow-up period. According to multi-slice CT coronary angiography, the results were impeccable, with an astonishing 100% patency observed in all 20 IMA grafts and 58 no-touch SVGs examined. Conclusions. The excellent patency rate during the early follow-up period confirmed that the no-touch technique is a good option for surgical revascularization.

Introduction. This study aims to evaluate the outcomes of three distinct configurations of No-Touch (NT) grafts used in coronary artery bypass grafting, focusing on the safety and efficacy of these techniques. Methods. Nine cases were analysed and categorized into three groups: Coronaro-Coronary NT Left Internal Thoracic Artery (LITA) non-aortic composite grafts; NT-LITA ‘Y’ composite grafts, and a Posterior Descending-Obtuse Marginal-Aorta NT vein graft. Results. In Group 1, no traditional proximal anastomosis was performed. The NT vein graft was distally anastomosed to the obtuse marginal branch in an end-to-side manner, followed by side-to-side anastomosis to the Ramus Intermedius (RI) or Diagonal, and a final end-to-side connection to the Ramus Interventricularis Anterior (RIA). In Group 2, where NT-LITA ‘Y’ composite grafts were utilized, the first graft was placed end-to-side and the second side-to-side, addressing either two marginal branches or the OM and RI branches. Proximal anastomoses were occasionally performed to the LITA or aorta. In Group 3, a sequential anastomosis was conducted, with the NT vein graft connected from the right posterior descending artery in an end-to-side manner, followed by a side-to-side connection to the OM branch. Patients had patent No-Touch vein grafts on their follow-up MSCT, without any post-surgery complications, except 2 cases where one had occluded marginal branches, and one LITA-RIA anastomosis. Conclusions. Different No-Touch graft configurations demonstrate high patency rates and a favorable safety profile. Overall, graft patency was preserved in most patients during follow-up, although several anastomotic occlusions were observed. These findings suggest NT grafts are a viable alternative to traditional methods, warranting further research into long-term outcomes and surgical refinements.

Giant coronary artery aneurysms are a rare and potentially life-threatening subset of coronary artery anomalies. They are most frequently detected incidentally and can pose significant management challenges due to their unclear natural history and risk of complications. Although aneurysm size often raises concern, current evidence does not uniformly support surgical intervention in all cases. We present the case of a 66-year-old asymptomatic male initially admitted for endovascular treatment of a 72 mm abdominal aortic aneurysm (AAA). Preoperative multidetector computed tomography (MDCT) angiography unexpectedly revealed two giant coronary artery aneurysms: a 75 mm aneurysm in the left anterior descending (LAD) artery and a 48 mm aneurysm in the right coronary artery (RCA). Coronary angiography showed no obstructive coronary artery disease or distal perfusion impairment. Given the absence of symptoms, preserved flow, and high surgical risk, the institutional Aortic Board opted for conservative management. Endovascular aneurysm repair (EVAR) was successfully performed for the AAA. At 12-month follow-up, the patient remained clinically stable, with no progression of coronary aneurysm size or endoleak. This case highlights the importance of individualized decision-making in patients with incidentally detected giant coronary artery aneurysms. In the absence of high-risk features, conservative management with close follow-up may be a safe and effective approach, even in cases with extremely large aneurysms.