he aim of treatment for acute myocardial infarction (AMI) is to restore full antegrade blood flow in the infarct-related artery (IRA) and minimize ischemic damage to the myocardium. Thrombolytic therapy is an option, but primary percutaneous coronary intervention (PCI) is the treatment of choice, based on lower rates of recurrent ischemia or infarction and good success rates in restoring antegrade blood flow in the IRA. 1,2 However, primary PCI is associated with a serious problem known as the no-reflow phenomenon (Thrombolysis In Myocardial Infarction (TIMI) flow ≤2), which occurs in 5-25% of cases. 3,4 Although PCI achieves full patency of epicardial arteries, patients who develop this phenomenon are at increased risk for left ventricular dysfunction, more progressive myocardial damage, and have higher rates of morbidity and mortality. 5,6 A number of studies have focused on the risk factors, but most of those investigators used nuclear imaging techniques, 7 myocardial contrast echocardiography, 8 Doppler flow measurements, 9 TIMI frame count method 10 or myocardial blush grade 11 to assess no-reflow phenomenon.Although these techniques have greater accuracy for detecting post-PCI suboptimal reperfusion, TIMI flow grade is the easiest and most commonly used method of evaluating primary PCI success. 12 The aim of this study was to identify simple clinical factors, angiographic findings and procedural features that predict no-reflow phenomenon in patients with AMI who undergo primary PCI. Methods Study PopulationThis prospective observational study was conducted in the Cardiology Department of Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital between January 2003 and February 2006. During this period, emergency cardiac catheterization was performed in 612 patients who (1) presented with AMI of ≤12 h duration or (2) were admitted between 12 and 24 h after onset with signs and symptoms of continuing ischemia. Exclusions were: patients treated conservatively for coronary artery spasm or ≤50% diameter stenosis of the culprit lesion with normal coronary blood flow; patients who required emergency surgical revascularization for severe left main coronary artery or Circ J 2008; 72: 716 -721 (Received May 15, 2007; revised manuscript received December 7, 2007; accepted December 25, 2007) Background The aim of the study was to identify clinical factors, angiographic findings, and procedural features that predict no-reflow phenomenon (Thrombolysis In Myocardial Infarction (TIMI) flow grade ≤2) in patients with acute myocardial infarction (AMI) who undergo primary percutaneous coronary intervention (PCI). Methods and Results A series of 382 consecutive patients with AMI underwent primary PCI within 12 h of symptom onset. Patients with ischemic symptoms continuing for more than 12 h were also included. Clinical, angiographic and procedural data were collected for each subject. Ninety-three (24.3%) of the patients developed no-reflow phenomenon, and their findings were compared with those of the reflow grou...

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Surgical management of cardiac myxoma gives excellent results. In selected cases, a conservative approach may be adequate. Despite the scarcity of the neoplastic properties, careful follow-up is necessary.

PAD, DM, and sheathed insertion technique are the major risk factors of ischemia during IABP use. Among all these risk factors, the only modifiable risk factor is the use of introducer sheath. With the presence of PAD and DM, the choice of sheathed method would increase the probability of ischemia almost 35 times. Sheathless method of insertion should be preferred in patients with DM and PAD.

Subaortic stenosis (SAS) is a wide spectrum of anatomical derangements ranging from a discrete fibrous membrane to tortuous fibrous tunnel with or without aortic annulus hypoplasia. We have reviewed 88 patients undergoing surgery for SAS over a 15-year period. There were 47 male and 41 female patients with a mean age of 19.8 +/- 10.6 years (range 11 to 39). Fifty-eight patients had discrete subaortic membrane, and 30 patients had diffuse tunnel subvalvular stenosis. The mean systolic pressure gradients were found to be 86.5 +/- 31.4 mmHg (range 48 to 145 mmHg). Ten patients had mild and 13 patients had moderate-to-severe aortic insufficiency (AI) preoperatively. Nine patients had bicuspid aortic valve. Forty patients (45.4%) had associated cardiac lesions. Isolated membranectomy was performed in six patients. Membranectomy associated with septal myectomy was done in 52 patients. Fifteen patients of them associated hypoplasia of the aortic orifice necessitated aortic valve replacement (AVR) using the Konno-Rastan procedure. Fifteen patients with tunnel SAS and normal aortic valves underwent a combined approach for valve sparing, a modified Konno procedure with patch septoplasty. Also eight patients required AVR because of the severity of AI and five patients aortic reconstruction procedures. Aortic commissurotomy was performed to relief of stenosis in four patients. There were three early deaths (3.4%) and one late death (1.1%) all after the Konno-Rastan procedure. Eight patients (9.1%) had permanent conduction abnormalities. Postoperative left ventricle-aorta gradient was significantly decreased at early postoperative period (p < 0.001) and ranged from 10 to 25 mmHg (mean 14.1 +/- 4.3). Fourteen patients (16.5%) were reoperated for recurrent obstruction or progression of AI. The mean reoperation interval was 4.4 +/- 1.7 years (range 2 to 8 years). Five-year reoperation-free survival was 88.0 +/- 3.6% and 12.5-year reoperation-free survival was 75.5 +/- 7.0%. Our results of aggressive surgical approach of subvalvular aortic stenosis produces relief of obstruction and frees the valve leaflets, significantly reducing associated AI with long-term survival and long-term adequate relief of left ventricular outflow tract obstruction.