Multidetector computed tomographic coronary angiography (MDCTA) has rapidly gained in popularity and applicability.¹ Most recently, the concept of MDCTA-guided percutaneous intervention has been introduced, with MDCTA evaluation of minimum luminal area dictating the need for intravascular ultrasound (IVUS), irrespective of the catheter-based appearance.² However, all published studies have dealt exclusively with its applicability to evaluation prior to catheter-based coronary angiography. The role of MDCTA as an adjunctive tool after catheter-based coronary angiography has not been addressed.

This issue of the Journal of Invasive Cardiology includes original research articles, a Rapid Communication, selections from the journal’s special section Clinical Images and online case reports which can be found in archive section on our website, as well as in the new Digital JIC at: www.invasivecardiology.com. I encourage you to visit the website to read these interesting and informative case reports. I would also like to thank all of the members of the editorial board and invited reviewers whose tireless efforts have resulted in the high-quality publications that have appeared in the journal throughout 2007.

Although drug-eluting stents (DES) show very good results in terms of early restenosis rates in patients with coronary artery disease as compared to bare-metal stents (BMS), there is little information available on the safety and efficacy of stent implantation for management of acute myocardial infarction (AMI).^1–4
The primary goal of the present outcome quality control registry was to investigate the safety of the Camouflage^® stent (Eucatech AG, Rheinfelden, Germany) with regard to serious cardiovascular events during the hospital stay and up to 6 months after the percutaneous coronary intervention (PCI) in patients with AMI. The secondary objective of the registry was to investigate the efficacy of the stent as reflected by the angiographic results and restenosis rates.

Case Report. A 75-year-old Afro-Caribbean male presented to our hospital with typical ischemic chest pain associat ed wi th a rai sed t roponin I l eve l of 3.5. His electrocardiogram (ECG) on admission showed anterolateral T-wave inversion. The diagnosis of non-ST-elevat ion myocardial infarction (NSTEMI) was made. He was treated with nitrates, low-molecular weight heparin, aspirin and clopidogrel. Past medical history included a previous non-Qwave inferior MI in 1994. He had no history of significant childhood fever.

Stenting has emerged as a procedure associated with low mortality and morbidity for symptomatic renovascular disease. Frequently responsible for uncontrollable hypertension, congestive heart failure and progressive renal failure leading to endstage renal disease, it is prevalent among elderly patients.¹ Acute pulmonary edema is not an infrequent presentation of severe renovascular disease in the elderly,² and carries high risk in patients will diminished cardiopulmonary reserve. In most cases, total occlusion of a renal artery supplying a small atrophied kidney has not been considered an appropriate target for intervention. This case demonstrates, however, that atrophied kidneys can be hormonally active, and therefore contribute to significant hypertension and pulmonary edema.

Distorted cardiac anatomy offers technical difficulties during fluoroscopy-guided transcatheter procedures. This is even more the case with percutaneous transvenous mitral commissurotomy (PTMC), where the cardiac malpositions considerably increase the complications involved in interatrial septal puncture and left ventricular entry. Though it has been established as the procedure of choice in a selected subset of patients with rheumatic mitral stenosis (MS), there are only a few reports on successful PTMC in altered cardiac anatomy using the standard Inoue technique.^1–6 Here we describe a case of a 43-year-old male with situs inversus and dextrocardia, where PTMC was successfully performed with a few modifications of the standard Inoue technique previously described in similar settings. Particular emphasis is given on the measures taken for optimal performance of transseptal puncture in this patient.

Isolated coronary artery spasm without atherosclerotic obstruction is an unusual cause of myocardial infarction (MI). The chest pain and electrocardiographic (ECG) changes can be resolved promptly following administration of nitroglycerin in the emergency department. The recommended longterm therapy includes calcium channel-blockers and nitrates. Although recurrent coronary artery spasm is associated with adverse outcomes,^1,2 data on the management and predictors of long-term outcomes are scant due to the rarity of the condition. Specifically, the optimal duration the patients have to be on medications as well as the risk of noncompliance remain unknown. We present a patient who developed spasminduced MI and cardiac arrest secondary to ventricular fibrillation after an event-free period of 6 years following the initial diagnosis of coronary artery spasm.

Case Report. A 22-year-old female presented to an outside hospital with back pain radiating to the epigastrum. The patient had a history of hypertension and Takayasu’s arteritis. At age 17 she underwent resection of an ascending aortic aneurysm via a median sternotomy with placement of a graft to the aortic arch and banding of the sino-tubular junction because of significant aortic regurgitation. Six weeks prior to her presentation with back pain, the patient underwent resection of a descending thoracic aortic aneurysm via a left posterior-lateral thoracotomy and placement of a 26 mm graft. This included resection of a portion of the aortic arch (hemi-arch) to the descending thoracic aorta just cranial to the diaphragm.

This case describes the closure of a patent foramen ovale (PFO) via the right internal jugular (IJ) vein in a young patient with an interrupted inferior vena cava (IVC) awaiting liver transplantation.
Case Report. A 25-year-old male with chronic liver failure due to Budd Chiari syndrome had a PFO discovered on contrast echocardiography as part of his transplantation workup. He was subsequently referred by the transplant team for PFO closure prior to liver transplantation to avoid the potential for intraoperative paradoxical embolism.

Late stent thrombosis (occurring more than 30 days after stent placement), is a catastrophic complication of drug-eluting stents (DES) that has recently gained heightened awareness. It has been reported to occur at a rate of 0.6% per year after DES placement, and is associated with mortality risk up to 25– 45%.^1–3 This has led to a critical evaluation of the role of DES in the current era of interventional cardiology. In this case report and brief discussion, we describe a patient who had simultaneous late stent thrombosis in two different coronary arteries, causing acute anterior and inferior myocardial infarction.