Chronic total occlusion (CTO) desobstruction of a native coronary artery in a post coronary artery bypass graft (CABG) patient can be a challenging procedure. In principle, the 3 basic approaches of recanalization of occluded native coronary arteries can be used: antegrade wire escalation (AWE), antegrade dissection re-entry (ADR) and a retrograde technique. On the other hand, a previous implanted saphenous vein graft (SVG) – even when occluded – can be used as a conduit for retrograde access. Moreover, access through a graft might be less complex compared to the use of septal or epicardial collaterals. If the graft is still open or has a tapered stump, this should be considered as a suitable conduit. Literature on recanalization of occluded native coronary arteries trough a diseased or occluded SVG is limited. A flowchart with an algorithm in post CABG patients is proposed and illustrated by 3 clinical cases.

Introduction: Nurses should be committed to undertake continuing professional development (CPD) courses to advance nursing practice and guarantee lifelong learning. Online CPD programs may allow nurses to fulfil the demand for specialty competency. Aim: This study focuses on utilising online (CPD) activities to develop cardiac nurses’ ability to perform advanced clinical skills. Method: The study was conducted in one of the largest accredited teaching hospitals in South Australia. The department is staffed by a specialised multi-professional team, some of whom have completed specialised cardiac post-graduation diploma courses in order to meet the complex needs of cardiac patients. To keep the team abreast of the latest developments in practice, the in-service education department at local study setting runs several CPD programs for the cardiology department via varied learning modes, such as online CPD programs, classroom learning and bedside-based learning. The nursing team maintains advanced clinical skills through online CPD, orientation programs, and in-service classroom-based courses. Regarding online CPD courses, electrocardiography interpretation and underwater sealing draining management courses are mandatory courses which all registered nurses must complete while working in medical or surgical cardiac wards. Results: The interview process was conducted in five stages: 1. Determining the type of the interview where in such types of qualitative studies the researcher should focus on the fundamental question of the phenomenological inquiry throughout the unstructured, in-depth interview process. 2. Making initial contact where the researcher established a rapport with the participant and prepared them mentally by giving them the participant information sheet. 3. Context of the interview where interviews be conducted in a quiet room in the School of Nursing in order to maintain participant privacy and anonymity, participants requested to conduct the interviews in their work setting. Nonetheless, the researcher ensured that participant privacy and anonymity was upheld. 4. Selecting the lived experience where Each participant was interviewed once. Interview duration was 15 to 30 minutes. The interviews started with a grand tour question. Grand tour questions are very broad questions asked by the interviewer at the early stage of an interview to obtain a description of the event or experience. 5. All interviews were concluded by thanking the participant and offering them the choice to have a copy of their interview transcript to verify what they had said. The researcher wrote an interview summary after listening to the interviews on the same day. The summary was prepared to help the researcher evaluate the amount of data gathered and identify whether the point of data saturation was reached. In addition, writing the summary helped the researcher reflect on the interview and gain an understanding of the participant experience Conclusion: This study explained the process of data collection, describing the setting, nature of participants and process of data collection using phenomenological interview. As the human experience is complex, gathering in-depth data should be systematic to ensure that the researcher has obtained the most sufficient data to explore the essence of the experience.

Telemedicine has been in existence for years with little traction for global mainstream medicine. COVID19 has exposed the importance of providing continued care for patients while minimizing the risk of exposure during pandemics. There has been robust growth in the use of telemedicine since the pandemic began rendering care possible while providing safety to patients and healthcare workers. Various digital applications are available to facilitate telehealth. Even in the absence of a pandemic, telemedicine allows the care of patients who may live in remote areas, or those who have issues with transportation or comorbidities prohibiting ambulation. This study is based on a questionnaire of providers who have been exposed to telemedicine during COVID19. A survey was shared in social media forums involving groups of physicians, and nurse practitioners who were willing to take the survey. Telemedicine is one of the best approaches to handling situations like pandemics or disease surges. In these circumstances, a virtual visit is beneficial for social distancing if a laptop, smartphone, or tablet is available, along with an internet or cellular coverage. Based on this survey conducted for healthcare workers from a variety of specialties, there was a considerable impetus for the continued benefit from telemedicine as an alternative to in-person visits for selected patients. Ongoing improvements in quality of applications/tools, education, and the cost are essential to maintain the benefits of telemedicine. There is also an ongoing necessity for vast improvements in healthcare policies and reimbursements.

Coronary artery anomalies (CAAs) are very rare a relatively uncommon, diverse group of congenital disorders of coronary arterial anatomy with a clinical presentations. Though most commonly detected incidentally finding during routine catheter, CT angiograms or at autopsy, these anomalies have generated considerable interest as they constitute the second most common cause of sudden cardiac death in young competitive athletes after hypertrophic cardiomyopathy1. Their prevalence ranges from 0.2% to 1.3% based published series 2-4. The most common coronary artery anomaly is origination of the left circumflex coronary (LCX) artery from the proximal of right coronary artery (RCA) or right sinus of Valsalva. The second is separate origination of the left anterior descending coronary artery (LAD) and LCX artery from the left sinus of Valsalva. Herein, we present five cases that the anomalous RCA arises from the left main coronary artery or the mid of left left anterior descending coronary artery (LAD). These cases are extremely rare. we bring forth them in an attempt to highlight their significance, and make cardiologist to understand what important the anomalies are, and how to diagnosis and treatment these bifurcation lesions of coronary anomalies.

Background: This study was designed to prospectively evaluate the changes in tissue Doppler imaging (TDI) at mitral and tricuspid annuli and two dimensional speckle tracking echocardiography in patients undergoing pericardiectomy for chronic constrictive pericarditis and identify the relationship if any of the tissue Doppler imaging and speckle echocardiographic derived variables with patient’s symptomatic status following surgery. Patients and Methods: Twelve patients undergoing pericardiectomy for constrictive pericarditis aged 7 years to 70 years (median 21; IQR: 19.75-26.5 years) were studied for 2-36 months (median 19 months). They underwent Doppler flow velocity, TDI, and 2D-speckle echocardiographic studies. Friedman’ test was used to test the changes in TDI-derived mitral and tricuspid annular velocities and speckle derived parameters in postoperative period from baseline. Results: Despite congestive heart failure, all patients had normal left ventricular ejection fraction and increased medial mitral and tricuspid early diastolic septal velocity (e¢) with “annulus reversus”. This pattern of annular velocity improved maximally in the immediate postoperative period. At closing interval, 2 (16.7%) patients continued to be in New York Heart Association class II and both of them continued to remain in atrial fibrillation. There was statistical significant improvement in the Global cirumferential strain than in global longitudinal and global radial strain after pericardiectomy. Conclusions: We conclude that tissue Doppler imaging and speckle tracking echocardiography are useful investigative modalities for serial evaluation of patients undergoing pericardiectomy. It can be performed serially with a high degree of reproducibility.