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doi:10.1510/icvts.2007.156273C eComment: I read with interest the paper by Dr Jalal w1x. First of all I appreciate all his efforts to come up with a solution to this difficult question of grading the diffuse coronary disease. I have a few points to make: • The definition of diffuse coronary disease needs to be revisited; is it a diffuse non significant distal narrowing or significant single or multiple lesions? In the second scenario, probe measurement of the vessel diameter is impossible because of varying degrees of narrowing. • According to the author’s grading system, the severe diffuse coronary disease needs to be surgically treated by enartrectomy, on-lay patch or more than one separate/sequential graft to the same coronary. This is the same group of vessels which were excluded from the study (85 grafts w15.4%x). That means he only included in his study vessels with normal, mild or moderate diffuse distal disease. • The incidence of DM in Dr. Jalal’s study is 66.7 % which is very high bu

ICVTS on-line discussion C The difficult question of diffuse coronary artery disease grading!