Transcatheter aortic valve implantation （TAVI） for aortic stenosis （AS） has rapidly become widespread in recent years, and its indications are expanding. Large-scale clinical trials in European Union （EU） and the United States （US） show that TAVI can achieve equivalent outcomes to surgical aortic valve replacement （SAVR） or TAVI might outperform SAVR even in low-risk patients. Based on these results, TAVI was approved for low-risk cases in EU and the US. The Japanese guidelines for the treatment of valvular disease in 2020 have been completely revised and TAVI for low-risk cases has been approved in 2021 in keeping with EU and the US. This article refers to current diagnostic methods, and surgical and transcatheter interventions for AS in the latest guidelines.
Coronary artery ectasia （CAE） is characterized by dilated coronary arteries more than 1.5 times in diameter than normal coronary arteries. It has been reported that CAE is present in 1-5% of patients undergoing coronary angiography and is more common in males. CAE can be caused by Marfan syndrome, Kawasaki disease, and atherosclerotic alterations with expansive arterial remodeling of the tunica media of the coronary artery as the most common cause. Although acute myocardial infarction has been reported to occur in 40-60% of patients with CAE, the therapeutic strategy to manage myocardial infarction caused by excessive thrombus remains unclear. Here, we report two challenging cases of acute myocardial infarction with CAE undergoing primary percutaneous coronary intervention.