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This study confirms the success of PMV and its results during follow-up. The Multi-Track system, and the DB resulted in the largest MVA, the IB and the single balloon resulted in the least increase in MR. The most common complication of PMV is the increase in the degree of MR.

Introduction: Acute STEMI is the most serious presentation of CAD. Restoration of the coronary flow facilitates cardiomyocyte salvage and decreases cardiac morbidity and mortality. However, reperfusion may result in paradoxical cardiomyocyte dysfunction, a phenomenon termed reperfusion injury. Trimetazidine is a metabolic anti-ischemic drug which is beneficial in reducing periprocedural myocardial reperfusion injury. The aim of the work is to study the effect of trimetazidine on myocardial salvage index in patients with acute STEMI who underwent primary PCI. Methods: Forty patients presented with acute STEMI, underwent primary PCI with injection of an intravenous dose of Tc-99m labeled Sestamibi before primary PCI then first set of SPECT images were taken within 6 h from injection time to assess the initial size of the perfusion defect. Prior to discharge the patients received another dose of Tc-99m labeled Sestamibi and follow up SPECT images were taken to assess the final perfusion defect and to calculate myocardial salvage and myocardial salvage index. Twenty patients of them received trimetazidine before primary PCI (study group) and the other twenty patients did not receive trimetazidine (control group). Results: (1) Patients with acute STEMI undergoing primary PCI who received trimetazidine before primary PCI had better myocardial salvage index, however it was statistically non significant. (2) Statistically significant better myocardial salvage index with post procedural TIMI 3 flow than with post procedural TIMI 2 flow among patients who received trimetazidine before primary PCI. Conclusion: In the presence of post procedural TIMI3 flow trimetazidine is beneficial in improving myocardial salvage index in patients presented with acute STEMI who underwent primary PCI.

Background: Leptin is a bioactive substance secreted by adipose tissue and exerts pleiotropic actions on glucose metabolism. It may promote atherosclerosis and increase cardiovascular events. Objective: The aim of this study was to determine the role of leptin as a risk factor in non-obese patients presented with acute coronary syndrome and its relation to midterm prognosis. Patients and Methods: The study included 60 non-obese patients who were presented to Coronary Care Unit (CCU) of Ain Shams University Hospital with acute coronary syndrome (ACS). Patients were classified into 3 Groups. Group A was composed of 30 patients presented with ST-segment elevation myocardial infarction (STEMI), Group B included 15 patients presented with non-ST segment elevation myocardial infarction (NSTEMI) and Group C included 15 patients presented with unstable angina. The study also included control group composed of 20 healthy non-obese subjects who gave no history of chest pain or symptoms suggestive of coronary artery disease (CAD). Results: Mean serum leptin level in all patients was significantly higher compared to control group. As regards complications; mean serum leptin level was higher in patients with adverse outcome compared to other patients. Conclusion:The concentration of leptin is positively correlated with ACS. The mean value of serum leptin in all patients was significantly higher compared to control. The study suggests that leptin is a significant cardiovascular risk factor for ACS independent of traditional cardiovascular risk factors. Serum leptin may be a useful marker in risk stratification of ACS.