Cardiac imaging plays an important role in detection and differential diagnosis of cardiac masses. We report a 43-year-old male presented with palpitations. Clinical examination, ECG and chest x-ray were unremarkable. Trans-thoracic echocardiography showed a well-defined, large left ventricular mass at the anterolateral papillary muscle with multiple chordal insertion into the mass. Cardiac computed tomography showed heterogenous contrast enhancement. Cardiac magnetic resonance imaging showed high signal intensity, and early heterogeneous enhancement hyperintense on T2, with regional variations in vascularity, as well as late gadolinium enhancement. Post-surgical excision pathological examination confirmed cardiac hamartoma.

Introduction: Coronary artery fistula (CAF) is a rare cardiac anomaly that typically presents as a continuous murmur in an otherwise asymptomatic patient. Occasionally, it can result in congestive heart failure or bacterial endocarditis. Objective: To better delineate the course of coronary artery fistula for the first time, using the SonoVue contrast agent during transthoracic echocardiography. Method and results: A referred 46-year-old male with a known history of dyspnea on exertion for a period of almost three months was admitted to the hospital with progressive dyspnea, and assessed under suspicion of CAF. CAF, was seen with a coronary angiogram, but the exact entry point in the left ventricle or left atrial wall could not be determined. CT angiography also failed to establish the exact point of entrance to LV (left ventricle), so CAG (coronary angiography) was repeated with SonoVue contrast agent injected into LM (Left main) while using a Siemens echocardiography machine. Multiple views were obtained during the injection, and revealed unusual flow in the left ventricle just below the PML (posterior mitral leaflet) postero-lateral and passing through the fistula to LV. Conclusion: Contrast Enhanced Echocardiography is thought to be more sensitive and in affording an accurate delineation of CAF drainage into cardiac chambers, and can be utilized in a direct precise and safe way.

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%.