The use of intracardiac echocardiography (ICE) is gaining wide acceptance as one of the most powerful imaging devices in the interventional catheterization laboratory and its usefulness in different clinical settings is well known. Today, many electrophysiological, percutaneous congenital heart interventions and some peripheral vascular interventions benefit from the use of ICE.^1–2 New and fascinating cardiovascular interventions such as percutaneous valve implantation and complex hybrid congenital heart disease repair are appearing on the pediatric and adult heart disease scenario, whereas others such as percutaneous valvuloplasty, atrial septal defect and patent foramen ovale transcatheter closure, stenting of baffles or conduit stenting are becoming front-line treatments for both simple and complex heart diseases.

Coronary artery bifurcation lesions remain a significant challenge for interventional cardiologists.

Intracoronary mononuclear cell therapy may lead to angiogenesis in chronic myocardial ischemia. A total of four cell therapy trials in patients with myocardial ischemia not amenable to revascularization have been performed.¹ Tse et al. studied transendocardial bone marrow cell transplantation guided by electromechanical mapping in a pilot study of 8 patients with severe ischemic heart disease via a percutaneous approach. All patients had an ejection fraction > 30 percent. Marrow (40 mL) was processed to isolate mononuclear cells prior to injection. At 3-month follow up, the mean number of weekly anginal episodes decreased, as did the number of nitroglycerin tablets consumed. Cardiac magnetic resonance imaging demonstrated significant increases in target wall thickening and motion.

Dear Editor,

Dear Readers,

This issue of the Journal of Invasive Cardiology includes original research articles, commentaries, a review, a CME offering and articles from the journal’s special sections Clinical Decision Making and Clinical Images. In addition, there are six case reports that are published as part of this issue of the journal on our web site (www.invasivecardiology.com). I encourage you to visit the web site to read these interesting and informative case reports.
The first research article, submitted by Dr. Yasunori Ueda and associates from the Osaka Police Hospital in Osaka, Japan, presents research in which the authors studied differences in plaque composition through angioscopic evaluation of patients presenting with ACS with and without CK elevation. They found that angioscopically-determined extent of coronary atherosclerosis was more advanced in ACS patients with CK elevation compared to those without CK elevation.

Dear Readers,

This issue of the Journal of Invasive Cardiology includes original research articles, commentaries, a review, a CME offering and articles from the journal’s special sections Clinical Decision Making and Clinical Images. In addition, there are six case reports that are published as part of this issue of the journal on our web site (www.invasivecardiology.com). I encourage you to visit the web site to read these interesting and informative case reports.
The first research article, submitted by Dr. Yasunori Ueda and associates from the Osaka Police Hospital in Osaka, Japan, presents research in which the authors studied differences in plaque composition through angioscopic evaluation of patients presenting with ACS with and without CK elevation. They found that angioscopically-determined extent of coronary atherosclerosis was more advanced in ACS patients with CK elevation compared to those without CK elevation.

Approximately 0.3–2% of patients may have anomalous origins of the coronary arteries.^1,2 Anomalous origin of the left coronary artery (LCA) or left anterior descending (LAD) artery from the right sinus has been well described. In persons in whom the course involves an interarterial track between the aorta (Ao) and pulmonary artery (PA), an increased incidence of sudden death has been reported,³ particularly during or shortly after exercise. This has been felt to be due to transient occlusion of the anomalous LAD from increased blood flow through the Ao and PA as the anomalous LAD courses between them, possibly causing myocardial ischemia.^4–6 In an elective setting, further anatomic delineation with other methodologies such as cardiac magnetic resonance (MR) imaging is recommended.

The majority of percutaneous coronary and renal artery interventional failures is due to the inability to deploy stents in patients with tortuous arteries, fibrotic lesions and/or calcified plaque. Approximately 3% of all interventional procedures are not successful despite current stent design and deployment techniques.¹ An earlier report on RotaGlide™ (Boston Scientific Corporation, Natick, Massachusetts) facilitated stent delivery in two cases has described the use of either dipping the stent into the undiluted lubricant or applying the lubricant to the surface of the stent with a syringe prior to inserting the stent into the guiding catheter.² This report demonstrates that injecting 2 cc of undiluted RotaGlide into the guiding catheter, when the stent is proximal to the lesion site in the artery, can facilitate stent delivery into patients

Case Reports

An isolated, single coronary artery is a rare congenital anomaly with an incidence of 0.03% to 0.4% and an uncommon finding (0.6% to 1.3%) in patients undergoing coronary angiography.^1,2 In this report we describe a rare case of a patient who had an anomaly of the left and right coronary arteries with a single coronary ostium in the right sinus of Valsalva, in which percutaneous coronary intervention (PCI) was successfully performed in both arteries.

Myocardial bridging is defined as systolic compression of an epicardial coronary artery segment underlying myocardial tissue.1 On angiography, it is recognized as systolic compression of an epicardial coronary segment resulting in systolic narrowing (milking effect) of that segment.¹ The prevalence of bridging ranges from 5% to 86% in autopsy series and from 0.5–7.5% in coronary angiography series.^1,2 Its detection may be enhanced by operator recognition of the phenomenon.² Myocardial bridging commonly involves the left anterior descending coronary artery (LAD), and to a lesser extent, the right coronary and the left circumflex arteries.¹ It is more prevalent in patients with transplanted hearts3 and hypertrophic obstructive cardiomyopathy.^4,5 Myocardial bridging of epicardial veins have also been observed at autopsy.⁶ To the best of our knowledge, the phenomenon of dynamic compression of bypass grafts supplying n