37-year-old-gentleman, who was presented in three occasional times to emergency department for a fast, precordial, and rhythmic symptomatic palpitations, in which the last episode was with a duration that lasted more than an hour with instability vitally that ended in performing emergency electrical cardioversion. All these episodes were symptomatic and last hospitalization was associated with pre syncopal and syncopal attacks. With evidence of Wolff-Parkinson-White syndrome the patient was brought to Electrophysiology Lab to EP study and ablation.

Background: Determining the optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) is a compelling topic. After the publication of two new trials, numerous meta-analyses on percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) appeared in the literature. This study set out to review the extent of published meta-analyses on PCI versus CABG in LMCAD, and stipulates the need for “quality over quantity”. Methods: A systematic search in Embase, Medline Ovid and Cochrane databases was performed to identify meta-analyses on PCI versus CABG in LMCAD. Meta-analyses that reported associations between revascularization and clinical outcomes were included. Study outcomes were reported according to descriptive statistics, without pooling study outcomes. Results: Fifty-one meta-analyses were included. Of those, 33 became available after EXCEL and NOBLE trial publication. The composite of major adverse cardiac (and cerebrovascular) events were reported in 41, and 49 reported all-cause mortality. Results varied among meta-analyses, depending on (i) randomized versus observational data, or a combination of both, (ii) methodology and effect-measures to report treatment-differences, (iii) varying sample sizes, and (iv) the year of publication. Conclusions: The number of meta-analyses on PCI versus CABG in patients with LMCAD, is disproportionate and urges the need for quality over quantity. To ensure future high-quality publications, we call on all authors, editors and reviewers to appraise the evidence already available and join forces to conduct individual patient data pooled analyses instead.

The care of acute coronary syndrome with persistent ST-elevation (STEMI) is a time-trial race: ‘‘time is myocardium”. The treatment relies on myocardial reperfusion by percutaneous coronary intervention (PCI) or fibrinolysis as promptly as possible. The main objective of this work was to assess the care time delays and the delaying factors during STEMI. We conducted a prospective, descriptive and analytic study over a 6 months’ time period. Were included all the patients received for STEMI. We have studied the care time delays and the delaying factors. We have compiled 50 patients. The mean age was 58.4 years and the sex-ratio M/F 2.5. The chest pain was typical in 39 patients. The mean time elapsed between the beginning of the pain and the first medical contact was 12 h 16 min. Transport (76%) and self-medication (70%) were the significant delaying factors found (p = 0.0001). The mean time elapsed between the first medical contact and the electrocardiogram was 9 h 57 min. The main factors delaying the diagnosis were the unavailability of the electrocardiogram device and the absence of electrocardiogram prescription (p = 0.001). The mean time elapsed between the electrocardiogram and the admission in the cardiology department was 3 h 02 min. The transport was the principal factor lengthening that time delay (p = 0.0001). Among the patients admitted directly in cardiology department, the mean time delay to perform the ECG was 30 min. The mean time delay of fibrinolysis was 2 h 11 min. Streptokinase shortage was the most frequent delaying factor (p = 0.001). The mean time delay between the qualifying ECG and the PCI completion was 2 h 42 min. The unavailability of the medical team was the first factor lengthening that time delay (p = 0.0001). The care time delays were lengthened enough in our context. This testifies to the lack of a codified strategy for STEMI care. It is essential to develop pre-hospital emergency medicine and sensitize the population and healthcare professionals.

Background: Noonan syndrome is a heterogeneous congenital disorder that can occur sporadically or inherited as an autosomal dominant disorder. It is characterized by a wide spectrum of phenotypic abnormalities that vary greatly in range and severity, and two patients with Noonan syndrome may have two different characteristic features. In many patients the syndrome characterized by craniofacial abnormalities including low set ears, hypertelorism , congenital heart defect, short stature, and undescended testes. Although pulmonary stenosis is the commonly associated congenital cardiac defects, a variety of cardiac defects may occur in this syndrome. Atrial septal defect, and patent ductus arteriosus are other well-recognized cardiac defects of this syndrome. The diagnosis of Noonan syndrome is entirely clinical as there is no specific diagnostic available Materials and methods: A ten month old boy who was referred to the pediatric neuropsychiatric clinic of the Children Teaching Hospital of Baghdad Medical City because of developmental delay associated with multiple congenital abnormalities was studied. Results: The boy had growth and developmental retardation, low set ears, hypertelorism, and smooth philtrum, undescended testes. Echocardiography showed interatrial septum, small atrial septal defect and closing patent ductus arteriosus. Conclusion: Noonan syndrome was previously reported only in one girl from Iraq. The first Iraqi boy with Noonan syndrome is reported in association with unique cardiac defects. The previously reported case and the case in this deport demonstrates the variability of the phenotype of this syndrome.

The formation of coronary artery aneurysm (CAA) is one of the critical complications after percutaneous coronary intervention (PCI). The most common aetiologies and aggravating factors for aneurysmal dilatation are acquired, such as atherosclerosis, Kawasaki disease, Takayasu disease, connective tissue disease, trauma after percutaneous coronary intervention (PCI) and infections. Cardiac catheterization itself carries a negligible bacteremic risk. We present the case of a patient who had infective coronary artery aneurysms that developed after PCI. A 63 years old male who had ST-T MI 1 month back and underwent primary percutaneous coronary intervention with deployment of 1 Des stent in Mid left anterior polymer-based paclitaxel-eluting stent 63 years having primary PCI for LAD 1 month back in the left anterior descending artery and A large aneurysm developed MID DES. The patient had C/O high grade fever only since 3 weeks remained asymptomatic then had angina at rest for 4 days. An aneurysm was diagnosed at middle of DES on repeat coronary angiography. Intravascular ultrasound demonstrated a true aneurysm about 5.6 mm in diameter. We will review the literature and discuss the causes specially infectious aneurysm and treatment option of aneurysm with stent usually detected at the time of repeat angiography for recurrent symptoms or as apart of the routine angiographic follow up [1].