Be prepared for the challenges of cath lab design.

This monthly column in Cath Lab Digest reviews important points of distinction in DES, from characteristics to techniques, so that physicians have valuable and relevant information about this revolutionary technology. This article, the first in a two-part series on diabetes, will discuss why diabetics are more predisposed to coronary artery disease (CAD) and will evaluate CAD treatment options for these patients. Part two will evaluate the data on drug-eluting stents (DES) in this patient population.

We describe a case of severe ischemic mitral regurgitation (MR) causing reversible cardiogenic shock as a complication of percutaneous coronary intervention (PCI) of the circumflex due to no-reflow. Baseline echocardiography before PCI showed only mild MR. After the occurrence of no-reflow post stenting, patient developed acute hypotension, hypoxia, pulmonary edema, increase in pulmonary mean wedge pressure to 42 mmHg with very high V-wave during pulmonary wedge tracing and cardiogenic shock requiring intra-aortic balloon pump (IABP) insertion. Urgent echocardiography revealed severe MR. With the establishment of normal flow in the circumflex artery after IABP insertion and intracoronary adenosine injections, severe MR, hypoxia and all hemodynamic instability resolved. We present this case as a first documented complication of PCI causing severe reversible ischemic MR leading to cardiogenic shock and a review of the literature.We conclude that in all patients with sudden unexplained he

Questions are answered by: Jason Wilson RCIS, Ellis Hospital Clinical Instructor Schenectady, New York

Banner Thunderbird Medical Center, Glendale, Arizona

This on-the-horizon system creates a 3-D stereoscopic image of patient anatomy that can be physically manipulated in virtual reality.