Anomalous coronary arteries occur in less than 2% of the general population. The left circumflex (LCx) artery's origin from the pulmonary artery as a cause of classic angina in adults is extremely uncommon. We report a case of ischemic heart disease due to an origin of the LCx artery from the right main pulmonary artery in a 33-year-old man. Successful surgical correction of this defect was performed with total cardiopulmonary bypass and cardioplegic arrest.

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PURPOSE: Pathology of the aortic root and aortic valve is subjected to adult cardiac surgery and includes Stanford A aortic dissection, annuloaortic ectasia or chronic aneurysm of the ascending aorta. In such cases, Bentall-De Bono procedure is usually preferred. Aortic valve reimplantation by using Tirone David's technique presenting with the advantages of valve-sparing surgery can be performed in selected cases. MATERIAL AND METHODS: A retrospective analysis of a three-year experience with the complex surgical treatment of diseases of the aortic valve and root was carried out. During the period from January 1, 2009 to December 31, 2012, fifty-three patients with aortic valve and aortic root pathology were treated in the Division of Cardiac Surgery, St. Marina University Hospital of Varna. Bentall procedure was carried out in 37 patients (Group B). In 19 of them (51%) emergency surgery was done for acute aortic dissection of type Stanford A. The rest 18 patients underwent elective surgery for dilated ascending aorta and aortic valve dysfunction. Aortic valve-sparing surgery by David's technique for aortic aneurysm was accomplished in 16 patients (Group D). This technique was emergently applied in one patient with aortic dissection, too. Baseline data, intraoperative details, early results and complications were compared. RESULTS: Early (30-day) mortality after Bentall-De Bono procedure was 10,5% (0% after elective surgery and 21,1% after dissection repair). All the patients survived after David's procedure that proved the significant advantages of the valve-sparing surgery. CONCLUSION: The aortic valve reimplantation provides long-term results that are comparable to those after the Bentall-De Bono procedure such as high survival rates, low incidence rate of endocarditis, and slightly higher risk of reinterventions. There is no need of lifelong anticoagulation that improves patient's quality of life.

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Up to 30 % of all ischemic heart disease patients present with some degree of ischemic mitral regurgitation. It is proven that any grade adversely affects long-term outcomes. Surgical revascularization and restoration of the valvular function both trigger left atrial and ventricular reverse remodeling and improve the prognosis.

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The echinococcal disease with a cardiac location of the hydatid cyst is uncommon and potentially fatal for the patient's life. The diagnosis could be difficult because no specific symptoms ever occur. However, this pathology should be always kept in mind in endemic regions. Herein we report a rare case of hydatid cyst situated in the right ventricular free wall. The diagnosis was ensured by transthoracic and transesophageal echocardiography, CT and MRI. The patient underwent a total cardiopulmonary bypass without aortic cross-clamping. Several ruptured daughter cysts were removed. The fibrous capsule was opened and the germinative membrane was extirpated. Postopeраtively, albendazole therapy was administered. No complications were reported.

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