Clipless skeletonized internal mammary artery harvesting with harmonic technology.

Since the introduction of the mammary artery harvesting procedure, electrocautery has been used as a standard method of care. However, mammary artery spasm, subadventitial haematoma and mammary artery damage due to clips dispositioning or high thermal energy injury have been recorded. To achieve a perfect mammary artery graft, we propose the usage of a high-frequency ultrasound device, usually recognized as a harmonic scalpel.

Polymorphic presentation of an acute aortic syndrome.

We describe a case of a patient with acute aortic syndrome referred to an emergent surgery. Aortic dissection presented with all-in-one imaging and pathologic entities: aortic dissection with intimal flap and true/false lumen, intramural hematoma and penetrating aortic ulcer. Usually, only one of these entities is present in a single patient, but it is possible that one entity evolve into or coexist with another.