We describe a case of severe ischemic mitral regurgitation (MR) causing reversible cardiogenic shock as a complication of percutaneous coronary intervention (PCI) of the circumflex due to no-reflow. Baseline echocardiography before PCI showed only mild MR. After the occurrence of no-reflow post stenting, patient developed acute hypotension, hypoxia, pulmonary edema, increase in pulmonary mean wedge pressure to 42 mmHg with very high V-wave during pulmonary wedge tracing and cardiogenic shock requiring intra-aortic balloon pump (IABP) insertion. Urgent echocardiography revealed severe MR. With the establishment of normal flow in the circumflex artery after IABP insertion and intracoronary adenosine injections, severe MR, hypoxia and all hemodynamic instability resolved. We present this case as a first documented complication of PCI causing severe reversible ischemic MR leading to cardiogenic shock and a review of the literature.We conclude that in all patients with sudden unexplained h

Recently, an everolimus-eluting stent utilizing a bioresorbabale PLA polymer coating to release the agent everolimus has proven safe and effective in preventing restenosis for up to six months in de novo coronary arteries. But the use of a bioresorbable polymer-coated everolimus-eluting stent for in-stent restenosis lesions has not been previously investigated. This is a case report of one-year angiographic follow-up results after the implantation of a bioresorbable PLA polymer-coated everolimus-eluting stent for the treatment of recurrent in-stent restenosis. The case involved a 63-year-old female who had repeatedly presented with recurrent in-stent restenosis in the LCX. We successfully treated this recurrent ISR lesion by using a bioresorbable PLA polymer-coated everolimus-eluting stent; the one-year follow-up angiography revealed prevention of ISR after the implantation of this device.

We describe the use of rotational atherectomy to ablate the unexpandable ring of a right coronary artery, already covered with a sirolimus eluting stent. Our experience adds to the growing evidence for the safety and effectiveness of the “stentablation” procedure.

When using vascular brachytherapy for in-stent restenosis, it is important to irradiate the edges with adequate safety margins to avoid the edge effect. This requires irradiation of uninjured, often “normal” areas of the artery, with little known about the potential damage of radiation to “normal” coronary artery tissue. The following case describes the development of new and significant disease in a proximal, normal appearing coronary vascular segment most likely a result of guiding catheter injury, during a brachytherapy procedure for more distal in-stent restenosis. This adverse effect of coronary brachytherapy has not been previously reported.

This case report describes a successful technique for handling high-risk PCI that combines 1) the advantage of the radial approach in decreasing access complications especially when an aggressive anticoagulation regime is preferred, with 2) the requirement for an (8 Fr) system to deliver the Symbiot™-covered stent to prevent distal embolization.

Acute right coronary artery occlusion following radiofrequency ablation. We report the first known case of acute right coronary artery occlusion following Radiofrequency (RF) ablation for atrial flutter in a patient without known prior coronary disease. Our patient developed acute chest pain and inferior ST-segment elevation immediately following the procedure. Emergent cardiac catheterization was performed, revealing an occluded distal right coronary artery, which was immediately stented. Acute coronary occlusion should be considered in the differential diagnosis of patients, with or without coronary artery disease, who experience chest pain following RF ablation for atrial flutter.

Aims. The aim of this prospective cohort study was to examine the correlation between the post-procedural absolute rise of cardiac troponin (cTn-I), cardiac troponin T (cTn-T), and creatine phosphokinase MB (CK-MB), and the predictive value of each marker for long-term cardiac events following successful percutaneous coronary interventions. Methods. The study consisted of 111 consecutive patients who had angiographically successful coronary balloon angioplasty with or without stent implantation. cTn-I, cTn-T, and CK-MB were measured before, immediately after the procedure, and every 6 hours for the first 24 hours. Patients were followed up for major adverse cardiac events, including acute myocardial infarction, death, recurrent angina, and revascularization for a period of 21 ± 8.2 months. Results. A total of 45 patients (40%) had post-procedural cTn-I elevation, 27 patients (24%) had cTn-T elevation, and 17 patients (15%) had CK-MB elevation. There were strong correlations between the

Transseptal puncture has recently been a very important therapeutic technique in the treatment of mitral stenosis1,2 and radiofrequency ablation of a left-sided accessory pathway.3 It has increased in importance since ablation for atrial fibrillation is performed in the left atrium by this technique. However, occasional puncture of the atrial free wall may result in bleeding into the pericardial space, which limits this method and increases the difficulty in mastering this technique. We present an improved method for the transseptal approach using a guidewire technique.

Background. Coronary microvascular dysfunction has been reported to be present in patients with hypertrophic cardiomyopathy (HCM) despite normal epicardial coronary arteries. In this study we aimed to evaluate coronary blood flow in patients with HCM by means of Thrombolysis In Myocardial Infarction (TIMI) frame count. Methods. Thirty-two patients with HCM (22 male, 10 female; mean age = 48 ± 7 years) and 36 healthy control subjects (23 male, 13 female; mean age = 49 ± 7 years) without any cardiovascular disease were included in the study. All patients and control subjects were selected from individuals who underwent coronary angiography and left heart catheterization in our hospital and were found to have angiographically normal coronary arteries. All patients had an asymmetrically hypertrophic nondilated left ventricle and a basal intraventricular pressure gradient > 30 mmHg recorded in the left ventricular outflow tract. A complete transthoracic echocardiographic examination includi

Background. Acetylcysteine may provide prophylaxis against contrast nephropathy (CN) in some patients. Its benefit may vary according to the characteristics of patients and contrast used. The objective is to evaluate the effectiveness of oral acetylcysteine in preventing CN after coronary procedures in our practice. Methods. We prospectively studied 397 patients with a creatinine level equal to or above 1.3 mg/dl, diabetes mellitus, or 70 + years of age who underwent a coronary procedure. Patients were randomly assigned to receive either acetylcysteine or placebo and 0.9% saline before and after the contrast agent. High- or low-osmolality contrast was used according to the discretion of the interventional cardiologist. Serum creatinine was measured before and 24 to 48 hours after the procedure. Results. An increase of >= 25% in the baseline creatinine level 24 to 48 hours after the procedure occurred in 14 (7.1%) of 196 acetylcysteine patients and in 17 (8.4%) of 201 placebo patients (

The study reports our single center experience in transulnar coronary interventions in 122 consecutive cases. Success rate was 85.2%. Vascular complications were low (5.7%) and minor (6 hematomas and 1 pseudoaneurysm treated by compression). Transulnar catheterization is feasible and safe. It represents a useful alternative to the transradial approach in selected cases.