The introduction of robotic systems in clinical cardiac surgery has offered the possibility to realize complete endoscopic cardiac operations. These computer-enhanced systems have been applied in coronary surgery, mitral valve surgery and in few simple congenital cardiac defects. Despite the good clinical results, operative times are still prolonged compared with standard surgery and a number of conversion has been reported. The early experience with robotic systems has been exciting although his application its limited to selected patients. Further development in these technologies could extend the application of these techniques to a larger group of patients.

Noninvasive magnetic resonance imaging (MRI) technology has the capacity to assess cardiac anatomy and function, promising significant advances in diagnosis and management of heart disease. However, as yet the technical and clinical results from MR imaging specifically of the coronary arteries have not been sufficient to substantially impact clinical care of patients with ischemic heart disease. Accordingly, an understanding of the imaging approaches, physical constraints and technical innovations, which contends with the physiologic and pathologic substrate of coronary atherosclerosis, is important. This paper reviews the technical development of MRI of coronary arteries: coronary magnetic resonance angiography (MRA). When suitably developed, coronary MRA will be the major clinical application of cardiac MRI. We will summarize the challenges that confront coronary MRA and the recent developments that make coronary MRA promising. We hope to provide the reader an informed appreciation of how coronary MRA is performed and thus how it may be used, now and in the foreseeable future.

Epicardial color-Doppler ultrasound scanning with a new phased array 10 MHz transducer allows easy approach to the external surface of the heart and satisfactory imaging of coronary stenoses and graft anastomoses. Epicardial color-Doppler ultrasound should become a further advancement to transittime flowmetry during coronary surgery.