The internal thoracic artery is the gold-standard conduit for coronary artery bypass surgery. Until recently, it was used almost exclusively as a pedicle, with construction of 1 distal anastomosis. Skeletonization of the internal thoracic artery has recently been advocated in order to increase the number of arterial anastomoses and decrease the occurrence of sternal wound infections. When skeletonized, the vessel loses its “milieu”, which raises the question of whether this technique sacrifices the superior longevity of the conduit. The current status of research on the effects of skeletonization (depriving the internal thoracic artery of vasa vasorum, innervation, and lymphatic and venous drainage, together with creating an imbalance between vasoconstricting and vasodilating substances) appears to support the superiority of the pedicled graft. Long-term patency studies of the skeletonized ITA, with meticulous follow-up and confirmation by angiography, are not currently available. Theoretically, skeletonization of the ITA might adversely affect its long-term resistance to atherosclerosis. More data are needed before this technique can be universally recommended. If the skeletonized ITA has decreased long-term patency, bypass surgery may be at a disadvantage when compared with the new generation of drug-eluting stents. (Tex Heart Inst J 2003;30:170–5)

Aneurysms of the sinuses of Valsalva, when detected before rupture, are repaired electively. When they are small, they are most frequently repaired by direct closure; when they are large, they are repaired with a prosthetic patch. When they are associated with prolapse of the corresponding aortic cusp and aortic insufficiency, valve replacement is usually performed concomitantly. We present the case of a patient in whom both abnormalities were corrected by implantation of a Freestyle® bioprosthesis, the wall of which completely excluded the aneurysm of the sinus of Valsalva. The patient remains asymptomatic 18 months after surgery. (Tex Heart Inst J 2003;30:202–4)