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BACKGROUND: Coronary artery bypass grafting (CABG) surgery is a common procedure for managing multi-vessel coronary artery disease to revascularize the myocardium. Among the various conduits used, the left internal mammary artery (LIMA) is preferred due to its better long-term patency rate. However, CABG procedures involving LIMA may result in rare but serious complications, such as avulsion of the LIMA post-CABG, which leads to disruption of blood flow to the myocardium and the development of fatal cardiac tamponade. CASE PRESENTATION: We hereby present a unique case of spontaneous avulsion of a LIMA graft to the left anterior descending artery (LAD) away from the site of anastomosis, twenty-four hours following CABG surgery in a 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed and resulted in successful stabilization of the patient's critical condition. However, this was followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection. CONCLUSION: Avulsion of LIMA graft following CABG is rare, yet a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported a few times in literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.

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Periaortic graft infections are a dangerous and extremely rare subtype of aortic graft infections (AGI). We hereby report a unique case of periaortic graft abscess in a 46-year-old male four months following a supracoronary ascending aorta replacement for DeBakey Type 2 dissection, resulting in the successful preservation of the original graft.

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In this case report, a 33-year-old male with a history of smoking presented with recurrent palpitations and chest discomfort. Holter monitoring revealed atrial flutter, and imaging showed a giant left atrial appendage aneurysm. Due to the risk of arrhythmias and thromboembolic events, surgical resection was performed successfully. This case underscores the importance of considering uncommon structural cardiac abnormalities in the evaluation of arrhythmia symptoms in young patients.

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Extra-cardiac stimulation after cardiac pacemaker implantation is seldom seen in the cardiac field. However, this case report demonstrates an unusual symptom of persistent abdominal twitching in a 42-year-old male patient who underwent pacemaker replacement, lasting for 15 years. Initially, it was attributed to diaphragmatic pacing by the new pacemaker. Despite several attempts to replace the endocardial leads, the patient's symptoms did not improve. Finally, he was referred to our hospital, where our team conducted further investigations and discovered that the old pacemaker lead was exposed, leading to excitation of the rectus muscle.

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Background: Iatrogenic diversion of inferior vena cava (IVC) to the left atrium (LA) after atrial septal defect repair (ASD) is an unusual complication. It rarely occurred nowadays due to trans-oesophageal echocardiography (TEE) check during surgery, but there are still few numbers of patients who survived from an old operation during childhood and reached adulthood undiagnosed. Case summary: We present a 27-year-old female post ASD repair in childhood with a unique presentation of recurrent abortion in adulthood besides exertional dyspnoea. A full workup of investigations was normal except for haemoglobin of 21 and oxygen saturation of 70%. TEE revealed abnormal drainage of IVC to the LA. Surgical correction was done to release the IVC opening to drain in the right atrium and the oxygen saturation reached 99% after weaning from the bypass machine. The postoperative course was uneventful, and the patient was discharged 5 days later. Two years later, she got pregnant twice and completed her pregnancies to term with well-developed infants. Discussion: The diversion of the IVC may be either complete or partial. Such complications may result in intraoperative death on the table or may present as early desaturation, shortness of breath, cyanosis, and clubbing, or it may present with such symptoms in adulthood. Rarely, it may present with cerebral stroke. Our case presented with the unexpected presentation of recurrent abortion. So, even if it is rare, echocardiography should be considered as a workup for recurrent abortion in a patient with a history of congenital heart surgery.

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We describe a case of severe peripheral vascular disease in a patient presenting for coronary artery bypass grafting (CABG). There was an occlusion of the abdominal aorta with collaterals from the internal mammary arteries (IMA) and inferior epigastric arteries (IEA) supplying the lower limb. Off-pump CABG was carried out without harvesting the IMA. In presence of concomitant severe peripheral vascular disease, lower limb blood flow should be evaluated with Doppler ultrasound, and in selected cases, computed tomography angiogram should be performed to rule out IMA-IEA collaterals dependent limb perfusion.

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Pulmonary embolism is a common clinical condition associated with high mortality.The majority of pulmonary emboli originate from deep venous thrombosis in the popliteal and femoral veins.We present a rare case of a 21-year-old caucasian male patient with massive pulmonary embolism. The source of emboli originated from thrombosed femoropopliteal pseudoaneurysm associated with arteriovenous fistula which was caused by a bullet injury 7 years before. The patient underwent successful surgical pulmonary embolectomy followed by aneurysmectomy with reconstruction of femoral and popliteal vessels.

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