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Percutaneous coronary intervention in severely calcified coronaries has been associated with higher rates of procedural complications, including myocardial infarction and death in addition to increased frequency of coronary revascularization on an intermediate and long-term basis. The SYNTAX score, which is designed to assess the complexity of coronary artery disease and aids in choosing a revascularization method, allocates two points per lesion when there is heavy calcification present on fluoroscopy. With the advent of novel multimodality imaging technologies, the detection and evaluation of coronary calcifications improved significantly over the last decade. Several tools are now available for modifying calcified lesions including different types of dedicated balloons and atherectomy devices, which may create some degree of confusion regarding the suitable application of each instrument. The aim of this review is to cover this vital topic from different aspects. First, we tried to provide an overview on the pathophysiology and types of coronary calcification and its risk factors. Then, we outlined the available imaging modalities for the evaluation of calcified coronary lesions, highlighting the points of strength and weakness of each of them. A comprehensive discussion of calcium-modifying techniques was elaborated, summarizing their mechanism of action, pros and cons, and possible complications. Finally, an integrated algorithm was proposed for the best management of calcified coronary lesions. [ABSTRACT FROM AUTHOR]

Background: In developing countries, rheumatic mitral valve stenosis (MS) is still a problem and its progression leads to left atrial (LA) damage. Due to the complexity of the LA geometry, currently used techniques like antero-posterior dimension (LAD) and 2D echo derived LA volume (LAV) have several limitations that are corrected by 3D derived LA volumes in addition to functional evaluation., Purpose: To assess the LA functions using 2D speckle tracking echocardiography and 3D transthoracic echocardiography in patients with clinically significant MS in comparison to normal healthy subjects., Results: Fifty patients and 50 healthy controls were studied. Patients' mean age was 40.2 ± 8.8 years, the majority were female 45(81.8%). 3D indexed LA maximum (LAVmaxI) and minimum (LAVminI) volumes were significantly higher in MS than in the control group, whereas 3D LA EF was significantly lower in MS than in the control group (p 0.001). LA strain reservoir, conduit, and contraction parameters were significantly lower in the MS group than in the control group ( p  = 0.001). However, only 3D LAEF, 2D LASr, 2D LAScd, and 2D LASct showed a correlation with the mitral valve area with a p  < 0.05, but 3D LAVmaxI and 3D LAVminI did not. Additionally, in the comparison of severe and very severe mitral stenosis subgroups, 3D LAVmaxI and 3D LAVminI did not show any statistically significant differences between the two groups, although 3D LAEF, 2D LASr, 2D LAScd, and 3D LASct showed significant difference between the two groups ( p  < 0.05)., Conclusions: Left atrial functional and structural remodelling has been highlighted in patients with significant rheumatic MS. However, left atrial functional assessment by 3D echocardiography and 2D speckle tracking echocardiography correlate better with mitral valve area than conventional LA size measurements. Whether the functional assessment of the LA has an additive predictive value with regards to patient outcome needs to be interrogated.