The integrated quality management system must be applied in order to achieve a high level of health care in the shortest possible time and with the least possible consumption of material and human resources. The application of this system in practice gives a realistic insight into the working processes and facilitates their functioning. It demands and requires constant monitoring of the system efficiency along with continuous changes and improvements of all elements of the working processes and functional units.

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The most common cause of coronary artery aneurysms is atherosclerosis, which is associated with over 50% of all aneurysms diagnosed in adults. Although patients can be asymptomatic throughout their lives, giant coronary artery aneurysms can manifest themselves as myocardial infarction, aneurysmal rupture, and sudden cardiac death as well. Herein, we describe an asymptomatic patient with numerous risk factors and a positive cardiopulmonary exercise test who was admitted to the cardiology clinic for coronary angiography. A giant coronary artery aneurysm (3.0×2.0 cm in diameter) in the left anterior descending coronary artery and significant stenosis in both left and right coronary arteries were found. After discussing possible treatment options, the hospital’s heart team recommended the surgical resection of the aneurysm and double coronary artery bypass graft. Four years after the cardiac surgery, at the time of writing the current manuscript, the patient is still in good condition and with no symptoms.

Evaluation of the etiology of proximal LAD subocclusive stenosis, including coronary artery vasospasm as a possible mechanism, is a very interesting issue in our case owing to the unexpected complete resolving of coronary pathology 8 years after left internal mammary artery-left anterior descending artery (LI-MA-LAD) cardiac surgery [1]. This possible mechanism that may be responsible for the complete disappearance of coronary pathology seen in 2004 is nicely questioned in the letter by Tomislav Miljak, MD, MBA.Coronary vasospasm as a cause of LAD stenosis was comprehensively evaluated by the heart team involved in the medical case. According to the heart team, the following events were decisive in supporting obstructive atherosclerotic (not vasospastic) characteristics of proximal LAD subocclusive stenosis: