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We report the case of a young man presenting with chest pain, dyspnea, and syncope in whom transthoracic and transesophageal echocardiography helped to diagnose anterolateral papillary muscle rupture. After cardiac catheterization (which confirmed the severe mitral regurgitation and showed two vessel coronary disease), mitral valve replacement was performed together with coronary bypass grafting.

Background: Percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCAD) have become a feasible and efficient alternative to coronary artery bypass surgery, especially in patients with acute coronary syndrome (ACS). There is limited data regarding early and late outcomes after ULMCAD PCI in patients with ACS and stable angina.The aim of this study was to compare early and four-year clinical outcomes in patients with ULMCAD PCI presenting as ACS or stable angina in a high-volume PCI center.Methods: We conducted a single center retrospective observational study, that included 146 patients with ULMCAD undergoing PCI between 2014-2018. Patients were divided in two groups: Group A included patients with stable angina (n=70, 47.9%) and Group B patients with ACS (n=76, 52.1%).Results: 30-day mortality was 8.22% overall, lower in Group A (1.43% vs 14.47%, p=0.02). Mortality and major adverse cardiac events (MACE) rates at 4 years were significantly lower in Group A (9.64% vs 33.25%, p=0.001, and 24.06% vs 40.11%, p=0.012, respectively). Target lesion revascularization (TLR) at 4 year didn’t differ between groups (15% in Group A vs 12.76% in Group B, p=0.5).Conclusions: In our study patients with ULMCAD and ACS undergoing PCI had higher early and long-term mortality and MACE rates compared to patients with stable angina, with similar TLR rate at 4-year follow-up.

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Background Left main percutaneous coronary intervention (PCI) has been established as an effective and safe treatment option for left main coronary artery disease. There are data suggesting that different stent platforms can impact the outcomes after left main PCI. The aim of current study was to compare the four-year outcomes of patients with left main stenosis treated by PCI with a balloon-expandable stent or a self-apposing stent. Methods and Results A total of 146 patients with left main stenosis treated by PCI were included, of which 84 (57.5%) had balloon-expandable stents (Group A) and 62 (42.5%) had self-apposing stents (Group B). Baseline SYNTAX scores were higher in Group A than in Group B. Proximal optimization technique was used more often in Group A (45.2% in Group B vs 81.4% in Group A, p<0.001). The same observations were made for kissing balloon postdilation (30.6% Group B vs 62.7% in Group A, p<0.001). Procedural success with TIMI 3 flow was achieved in similar proportions in both groups. Mortality rate and MACE rates at 4-year follow-up were higher in Group B compared to Group A but have not reached statistical significance in univariable or multivariable analysis. Implantation of a self-apposing stent has been an independent predictor for target lesion revascularization rate (TLR) in multivariable analysis (HR 0.06, CI − 1.11–11.7, =0.03). Conclusions In our study, TLR rate was significantly higher in patients with left main lesion treated by PCI with self-apposing stents.