Hypertension is a common disease in the elderly associated with significant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specifically designed to study the efficacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benefits in the positive studies were demonstrated even with a minimal BP control (systolic BP [SBP] <150 mmHg) and continued to be reported for a SBP <120 mmHg. On the other hand, keeping SBP <140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BP target in very old patients or those with multiple comorbidities.

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De Winter pattern in anterior leads has been extensively described. However, there is only one case report of this pattern in inferior leads in English literature. Here, we describe a case of acute inferior wall myocardial infarction with thrombotic right coronary artery occlusion who presented with the classical De Winter sign in inferior leads.

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Coronary intramural hematoma (CIH) after percutaneous coronary intervention (PCI) is a rare cause of acute coronary syndrome. As the diagnosis is really challenging, its incidence is really under estimated. The optimal management of post-PCI CIH has not been well defined. Conventional coronary angiography alone is often insufficient to identify a CIH. Intravascular ultrasound and optical coherence tomography (OCT) are helpful modalities for diagnosis and evaluation of its extension. We present a case of CIH after PCI, highlighting our experience in the diagnostic accuracy of OCT and our strategy in the management of this case.

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Objectives: We studied immediate and midterm results of transcatheter closure of atrial septal defects (ASDs) using the Amplatzer septal device closure. Methods: The study included one hundred and thirty-seven patients (31 men, 106 women; mean age 8 ± 7.3 years; range 1–65 years) who underwent transcatheter closure of secundum ASD between October 2014 and October 2016 in our center. All the patients were evaluated by transthoracic echocardiography before and during the procedure and in adult patients; transesophageal echocardiography was performed before the procedure. Closure of ASDs was performed under general anesthesia with transthoracic echocardiographic guidance. Follow-up controls were done on the day after procedure, 1 week, 1, 3, 6, and 12 months, and annually thereafter. The median follow-up periods of ASD was 15 months. Results: The mean ASD and device size were 13.5 ± 2.3 and 14.3 ± 3.2 mm, respectively. The mean procedural and fluoroscopy times were 21.3 ± 4.7 and 5.1 ± 1.9 min. Immediate complications such as mortality, bleeding, fatal arrhythmia, and device embolization did not occur in any patient during and after the procedure. Cardiac arrhythmias were seen in 4 patients during the 1^st month after the procedure. Late device embolization did not occur during the follow-up. No residual shunts were seen after the procedure. Transient ischemic attack was seen in one patient during the procedure and in one patient 2 days after the procedure without long-term complication. Conclusion: Transcatheter closure of ASDs using the Amplatzer devices is an efficacious and safe therapeutic option.

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Background: This study was designed to investigate the anatomical relationship of the different levels of aortic root. Materials and Methods: The morphological features of the aortic root were examined using of 12 adult hearts from fixed male cadavers who had expired due to noncardiac causes by magnetic resonance imaging and applied mathematical analyses to the results. The measurements of the aortic root were done at four levels: at the ventriculoarterial junction (annulus), at the largest level of the Valsalva sinuses (sinus), at the level of commissures (sinotubular junction [STJ]), and at 1 cm above the STJ (aorta ascendens). We derived an equation that allows calculation of the appropriate diameter of the aortic root from four levels. Statistical analysis among the variation of the diameters at the four levels of aortic root was achieved using test one-way analysis of variance. Results: The data showed a geometric pattern of the aortic root. The comparison of the values from four levels showed that the narrowest at the sinotubular junctional level and the widest at the sinus level. Conclusion: The analysis of our data shows that the aortic root has a consistent shape with varying size and that is a definable mathematical relationship between root diameter.

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Supravalvular aortic stenosis is the least common type of left ventricular outflow tract obstruction. Primary balloon dilatation of membranous supravalvular aortic stenosis was performed in a 10-year-old male child with a remarkable reduction in systolic pressure gradient. Balloon dilatation is a feasible treatment modality for membranous supravalvular aortic stenosis. It provides good immediate results and sustained relief of stenosis.

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In-stent restenosis (ISR) has been an area of concern for the interventional cardiologists since the era of bare-metal stents (BMS). Although the incidence of ISR is more with BMS as compared to drug-eluting stents, due to the underlying pathophysiological differences, between the two; the latter has a more accelerated course and is difficult to treat. In this case report, we try to address this issue of difficult treatment of ISR and the benefit of using optical coherence tomography in these situations.

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