Dear Readers, This issue of the Journal of Invasive Cardiology, which coincides with the American College of Cardiology Annual Scientific Sessions, includes original research articles, case reports, editorials, a review, and articles from the journal’s special sections Peripheral Vascular Disease, Electrophysiology Corner and Clinical Decision Making, as well as our new section, titled Rapid Communication, which will feature quickly reviewed articles on a variety of timely and urgent topics. The first research article, submitted by Dr. Eric Eeckhout and collaborators from the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, describe their approach to ostial left main stenting. They demonstrate the importance of IVUS in assessing the placement of drug-eluting stents in these patients. Dr. Tim Fischell, Professor of Medicine at Michigan State University and Director of the Heart Institute at Borgess Medical Center in Kalamazoo, Michigan, has provided an excellent commentary on this important clinical issue and provides further clarification of the decision process involved in the treatment of left main disease. In the second original research article, Professor George Joseph and colleagues from the Christian Medical College in Vellore, India, describe the development and testing of an over-the-wire, single balloon system to perform mitral valvuloplasty. They demonstrate that this technique is simpler, safer and more economical than double balloon mitral valvuloplasty, with comparable outcomes. The third original research article by Dr. Henning Bagger and associates from Viborg Hospital in Denmark, compared results of changing from routine transfemoral access to transradial access in coronary angiography procedures. They found that the transradial approach was very successful and reduced procedure time as compared to the transfemoral approach. In the next original research article submitted by Dr. Yanming Huang from the Department of Cardiology at the University of Leuven in Belgium, along with collaborators from the University of Antwerp and Tongji Medical College in Wuhan, China, presents their research in the oversized porcine coronary artery model using tacrolimus-coated stents which control neointimal hyperplasia and may reduce the occurrence of in-stent restenosis. Their study showed that tacrolimus effectively reduced neointimal hyperplasia in this model. In the last research article, Dr. Kin-Lam Tsui and associates from the Department of Medicine at the Pamela Youde Nethersole Eastern Hospital in Hong Kong, describe their approach to the effective implementation of a comprehensive infection control program in the cardiac catheterization laboratory to counteract the effects of SARS or other epidemics that may occur in the future. Dawn Powers, CRT and Dr. Joseph Carver of the Cardiovascular Division and Abramson Cancer Center of the University of Pennsylvania, Philadelphia, provide a thoughtful commentary on this important article. Next, in the new Rapid Communication section, Dr. Jeanne Jacoby and associates of the Emergency Medicine Department at St. Luke’s Hospital in Bethlehem, Pennsylvania, discuss the before-and-after study their institution conducted to determine whether an emergency department strategy which calls for cath lab activation directly by the emergency physician is effective in decreasing door-to-balloon time. This issue of the journal also includes case reports on interesting topics, as well as case reports with brief reviews of the literature. In the first case report with brief review, Drs. Kohsaka, Ferguson and Hernandez-Vila from the Department of Cardiology, Texas Heart Institute, St. Luke’s Episcopal Hospital, report on their use of direct stenting and placement of a distal protection device after laser angioplasty in a saphenous vein graft with severe stenosis. They review the literature related to this situation that is extremely difficult to treat. In the second case report with literature review, Dr. Thom Dahle and associates from the University of Minnesota Department of Medicine and Division of Cardiology, describe a case in which trauma played a role. They describe their management strategy using coronary artery stenting for acute myocardial infarction secondary to mild blunt trauma to the chest of a soccer player. The next case report, submitted by Drs. Goodfellow, Schwartz and Leya, from Loyola University Medical Center, describes an unusual finding in a patient referred for cardiac surgery who was found to have dark pigmentation of the aorta and coronary arteries. This condition was found on pathology analysis to be cardiovascular ochronosis due to alkaptonuria, a rare inborn error of metabolism. In the next case report with brief review, Drs. Gregory Giugliano, Nicholas Cox and Jeffrey Popma, from Brigham and Women’s Hospital and Baystate Medical Center, in Springfield, Massachusetts, discuss a case involving the unusual complication and management of cutting balloon entrapment during the treatment of in-stent restenosis. A case report by Drs. Holzer, Concillo and Hijazi from the University of Chicago and Children’s Hospital in Chicago, describes their innovative solution to managing a descending thoracic aortic aneurysm after repair of coarctation of the aorta in a 13-year-old boy. Using a self-fabricated covered stent, they were able to successfully exclude the aneurysm by placing a tube graft surgically and following this with percutaneous insertion of the covered stent. In the next case report, Dr. Nirav Raval and colleagues from Tulane University Health Sciences Center in New Orleans, Louisiana, describe their approach to treating a patient who presented post-bypass surgery with angina and wall motion abnormality with a large internal mammary artery with no lesions, but with a significant side branch. The authors were able to reinstate flow by using coil embolization of the vessel. Drs. Pavel Guigauri and Harold Dauerman, from the University of Vermont, present a case in which they were able to successfully use a distal protection device to retrieve a stent. In the next case report, Dr. Debabrata Mukherjee and collaborators from the University of Michigan Health System University Hospital in Ann Arbor, Michigan, present a young female patient who presented with exertional angina and was found on CT angiography to have an anomalous origin of the right coronary artery that was corrected with surgical intervention. Next, a case report by Dr. Sai Devarapalli, from St. Vincent’s Hospital and colleagues from the Krannert Institute of Cardiology at Indiana University in Indianapolis, describes the successful use of a self-expanding covered stent graft that was placed in a diseased saphenous vein graft with a leaking pseudoaneurysm, thus avoiding repeat bypass surgery in the patient. Four of our other special sections are featured in this issue of the journal. In the first of these, Acute Coronary Syndromes, our section editor, Lloyd Klein has submitted a manuscript, co-authored by Drs. Katsamakis and Kozinski from Rush University Medical Center in Chicago. This report describes a patient who had delayed healing of a coronary artery plaque ulceration that was associated with an acute infarction related to the use of a paclitaxel-eluting stent. In our section covering Interventions in Peripheral Vascular Disease, edited by Dr. Frank Criado of the Division of Vascular Surgery at the Union Memorial Hospital /Medstar Health in Baltimore, Maryland, Drs. Jose Diaz and collaborators from the Buenos Aires, Argentina, report on their approach using endovascular treatment of stenosed anomalous left gastric artery, thus avoiding a high risk surgical intervention. In the Electrophysiology Corner, edited by Dr. Todd Cohen of the Department of Cardiology at Winthrop-University Hospital in Mineola, New York, Dr. Mohsen Sharifi and collaborators from Texas Tech University, present a patient with “Twiddler” syndrome, which is an uncommon complication of pacemaker and ICD implantation. They discuss their management of the patient. In the final special section, Clinical Decision Making, edited by Dr. Michael Sketch from the Department of Cardiology at Duke University, Drs. Lingegowda, Marmur and Cavusoglu from SUNY Downstate Medical Center in Brooklyn, New York, present an unusual case in which a catheter-induced spasm occurred in the left main coronary artery due to anatomic kinking in its course. Several commentaries are included describing approaches and further analysis of this case. Drs. Elizabeth Bazemore and J. Tift Mann of the Wake Heart Research Center and Wake Heart Associates have provided an excellent and timely review of the problems and complications of the transradial approach for coronary interventions. This issue of the journal is completed with two important editorials. First, Dr. Francesco Burzotta and collaborators from the Institute of Cardiology at Catholic University in Rome, Italy, discuss the use of a second “buddy” wire during PCI to overcome challenging situations. They give specific recommendations for the circumstance most likely to profit from this approach. And finally, Dr. Alex Zapolanski from the San Francisco Heart and Vascular Institute at Seton Medical Center in Daly City, California, discusses the use of the off-pump approach in contemporary cardiac surgical practice. It is my hope that all of the articles in this issue of the journal provide healthcare professionals with valuable information that is useful in the daily care of patients with cardiovascular disease.