Likewise the 1991 Gulf War, known as a “mother of all battles”, oxidative stress (OS) can be considered as a “mother” of many human diseases life threatening. OS is a condition in which oxidation exceeds the anti-oxidant reactions, causing an imbalance between oxidative and anti-oxidant systems, with prevalence of reactive oxygen species ROS [1-5]. These include: peroxide, superoxide, hydroxyl radical, singlet oxygen and others. Under normal conditions ROS are maintained at physiological levels by several endogenous antioxidant systems, as superoxide dismutase, catalase, glutathione peroxidases, lacto-peptidases, glutathione reductase and others [6]. However, if active ROS are excessively generated, the balance between the formation and the removal of these species is lost. Generating oxidative damage (disruption between antioxidant defenses and ROS production) [7]. ROS can be generated from both endogenous and exogenous sources. Endogenous ROS are produced in normal metabolic reactions. Exogenous ROS derive by exposure to cigarette smoke, environmental pollutants, consumption of alcohol in excess, exposure to ionizing radiations, viral and bacterial infections, and others [8]. Individual, hereditary factors, and lifestyle are the main determinants of OS.

Coronary artery aneurysm is a rare disease diagnosed in 0.3 to 4.9% of patients undergoing coronary angiography. The incidence of left main coronary artery aneurysm (LMCAA) is extremely rare: 0.1% [1]. Coronary artery aneurysm involves the right coronary artery, the left anterior descending and circumflex coronary arteries in descending order of frequency [2] and atherosclerosis is the most common cause. Other causes include arteritis, Kawasaki disease, angioplasty sequelae, laser procedures, traumatic injury, dissection, connective tissue disorders, Takayasu’s arteritis, congenital (anomaly or genetic disorders such as Ehler-Danlos syndrome, Marfan syndrome) mycotic and idiopathic diseases. Although surgery has been recommended to prevent complication, there are no large available data comparing medical and surgical therapy [3-5]. The LMCAA is a rare clinical entities, encountered incidentally in approximately 0.1% of patients undergone routine angiography [6,7]. The sizes of LMCAAs may be fusiform or saccular. Management of these cases is still controversial, based on anedoctal experience rather than controlled trials.

Tetrahydrobiopterin (BH4) is an essential cofactor that controls the enzymatic activity of aromatic amino acid hydroxylases as well as all forms of nitric oxide synthase (NOS), which include endothelial (eNOS), neuronal (nNOS) and inducible (iNOS) isoforms [1]. In coronary arteries, reduced availability of BH4 in the endothelium causes decreased production of nitric oxide and an increase in eNOSderived production of reactive oxygen species including superoxide anion and hydrogen peroxide [2,3]. Studies have demonstrated that oxidative stress causes uncoupling of eNOS and endothelial dysfunction, which is associated with chemical inactivation of BH4 and its oxidation to dihydrobiopterin (BH2) [4]. There is mounting evidence that this mechanism plays a particularly important role in coronary artery disease (CAD). For instance, low BH4 and BH4/BH2 ratio have been found to be decreased in plasma of patients with CAD and in blood vessel wall [5]. BH4 levels are reported to be reduced in heart tissue from rodent models of cardiac ischemia that results in NOS decoupling [6-8].

Heart failure is a common cardiovascular disease with a high morbidity and mortality despite advances in medical and devicerelated management. Cardiac resynchronization therapy (CRT) which is also known as biventricular pacing has proven to be an effective treatment in heart failure [1-6]. However, CRT is generally recommended for patients in sinus rhythm and prolonged QRS complex (= 120 ms) with left bundle branch block (LBBB), or a QRS complex width of = 150 ms in the absence of LBBB [6]. On the other hand, only 30-40% of all heart failure patients show such a prolonged QRS complex [7,8] and therefore the 60-70% of patients who have a normal QRS complex cannot be treated with CRT. Furthermore, around 30% of the patients eligible for CRT treatment do not respond to CRT [7,8].

Recently, the use of percutaneous coronary intervention (PCI) for treatment of coronary artery disease has progressively increased. A large number of simple stenoses in one or two coronary vessels can be treated by PCI. Therefore, the number of high-risk and severely diseased patients referred for coronary artery bypass grafting (CABG) has been relatively increasing. Coronary endarterectomy has been used to treat severely or diffusely diseased coronary arteries since the 1950s [1]. More recently, the benefits of endarterectomy for the left anterior descending artery (LAD) have gradually become recognized because surgical techniques and technologies have evolved. The greatest advantage of endarterectomy is that the myocardium supplied by the side branches (diagonal branches and septal perforators) of a diffusely diseased LAD can be relieved of ischemia. This advantage cannot be obtained using a conventional graft to the distal LAD alone because this is beyond the diffusely diseased segments.

Background: Kawasaki disease (KD) is an acute vasculitis often complicating coronary arterial lesions, and gradually becomes the leading cause of acquired heart disease instead of rheumatism. Previous studies often regards elevation of serum lactate dehydrogenase (LDH) level as an auxiliary diagnosis marker when judging myocardial diseases.