Novel neurodigital interface reduces motion sickness in virtual reality.

Virtual reality (VR) is a computer-created 3D environment with a focus on realistic scenes and pictures created for entertainment, medical and/or educational and training purposes. One of the major side effects of VR immersion reported in the scientific literature, media and social media is Visually Induced Motion Sickness (VIMS), with clinical symptoms such as disorientation, nausea, and oculomotor discomfort. VIMS is mostly caused by the discrepancy between the visual and vestibular systems and can lead to dizziness, nausea, and disorientation. In this study, we present one potential novel solution to combat motion sickness in VR, showcasing a significant reduction of nausea in VR users employing the META Quest 2 headsets in conjunction with a whole-body controller. Using a neurodigital approach, we facilitate a more immersive and comfortable VR experience. Our findings indicate a marked reduction in VR-induced nausea, paving the way to promote VR technology for broader applications across various fields.

Pulmonary aspergilloma.

INTRODUCTION: Aspergillosis is a serious pathologic condition caused by Aspergillus organisms and is frequently seen in immunocompromised patients. Aspergillus species causes a variety of pulmonary diseases such as saphrophyticus (aspergilloma/mycetoma), hypersensitivity reaction (allergic bronhopulmonary), semi- invasive (chronic necrotizing) and angioinvasive aspergillosis. CASE REPORT: We report a case of pulmonary aspergilloma (PA) in 38 years old patient who was previously healthy with complaints of fever and hemoptysis. PA was diagnosed radiologically and confirmed by serology. CONCLUSION: Oral itraconazole was administered. The patient responded well to the treatment with improvement in his systemic symptoms and regression of the pulmonary lesions.

Disturbance of oxidative balance in the first trimester of spontaneous abortions.

Background/Aim: Pregnancy is defined as a condition of increased oxidative stress. The aim of this research was to determine the intensity of pro-oxidative processes and the content of GSH, as well as antioxidative enzymes: superoxide dismutase (SOD), catalase (CAT), gluthatione peroxidase (GSH-Px), and the total antioxidative status (TAS) in patients with spontaneous abortions. Methods: A total of 120 patients were involved in the research (70 spontaneous abortions and 50 healthy pregnancies). The patients were divided into groups: 35 patients with incomplete and complete spontaneous abortion (group S), 35 patients with missed abortion (group M) and a control group of 50 healthy pregnancies (group N), all of them being in the first trimester of pregnancy. The intensity of lipid proxidation (LPx) was determined with a modified thyobarbituric acid method. The GSH content in erythrocytes was determined by the method ba-sed on the amount of non-protein sulfhydryl residues using the Ellman's reagens. The following antioxidative parameters in the blood were measured: SOD ­ by the method with xanthine oxidase-using commercial RANSOD sets; CAT ­ by the method of Aebi (the enzyme activity was measured by monitoring the decomposition of H2O2 at 240 nm); GSH-Px was determined using hydrogen peroxide as a substrate. The TAS was determined using the ferric reducing autioxidant potential (FRAP) met-hod. Results: The highest average value of LPx was recorded in the spontaneous abortion group (48.03 pmoL/mg Hgb), and the lowest value was recorded in the control group (26.06 pmoL/mg Hgb). A statistically significant positive correlation between LPx and CAT in the group of patients with missed abortion was also noted (p < 0.05, r = 0.37). There was a statistically highly significant difference (p < 0.001) in SOD and in CAT activitices be-tween the examined patients (groups S and N) and the control group (Student's t-test and ANOVA). The highest average value of TAS was recorded in the group S (710.39 µmol/L), while the value in the group M was 277.66 µmol/L. The average value of TAS in the control group was 452.12 µmol/L. Student's t-test showed a statistically highly significant difference in the values of TAS between the examined patients (groups S and M) and the control group. Conclusion: Determination of the value of pro-oxidative and antioxidative parameters in patients with sponta-neous abortion can be the indicator of condition of fetoplacental unit and these analyses can be included in the protocol of the rutine perinatal diagnostics.

THE REGULATION ROLE OF CAROTID BODY PERIPHERAL CHEMORECEPTORS IN PHYSIOLOGICAL AND PATHOPHYSIOLOGICAL CONDITIONS.

INTRODUCTION: The major oxygen sensors in the human body are peripheral chemoreceptors. also known as interoreceptors- as connected with internal organs, located in the aortic arch and in the body of the common carotid artery. Chemoreceptor function under physiological conditions. Stimulation of peripheral chemoreceptors during enviromental hypoxia causes a reflex-mediated increased ventilation, followed by the increase of the muscle sympatic activity, aiming to maintain tissue oxygen homeostatis, as well as glucosae, homeostatis. Besides that, peripheral chemoreceptors interact with central chemoreceptors. responsible for carbon dioxide changes . and they are able to modulate each other. Chemoreceptor function in pathophysiological conditions. Investigations of respiratory function in many pathological processes, such as hypertension, obstructive sleep apnea, congestive heart failure and many other diseases that are presented with enhanced peripheral chemosensitivity and impaired functional sy mpatholysis ultimately determine the peripheral chemorcceptor role and significance of peripheral chemoreceptors in the process of those pathological conditions development. Considering this, the presumed influence of peripheral chemoreceptors is important in patients having the above mentioned pathology. CONCLUSION: The importance and the role of peripheral chemoreceptors in the course of the breathing control is still controversial, despite many scientific attempts to solve this problem. The main objective of this review is to give the latest data on the peripheral chemoreceptor role and to highlight the importance of peripheral chemoreceptors for maintaining of oxygen homeostasis in pateints with hypoxia caused by either physiological or pathological conditions.

Very late stent thrombosis of bare-metal coronary stent nine years after primary percutaneous coronary intervention.

Introduction: Stent thrombosis (ST) in clinical practice can be classified according to time of onset as early (0­30 days after stent implantation), which is further divided into acute (< 24 hours) and subacute (1­30 days), late (> 30 days) and very late (> 12 months). Myocardial reinfaction due to very late ST in a patient receiving antithrombotic therapy is very rare, and potentially fatal. The procedure alone and related mechanical factors seem to be associated with acute/subacute ST. On the other hand, in-stent neoathero-sclerosis, inflammation, premature cessation of antiplatelet therapy, as well as stent fracture, stent malapposition, un-covered stent struts may play role in late/very late ST. Some findings implicate that the etiology of very late ST of bare-metal stent (BMS) is quite different from those following drug-eluting stent (DES) implantation. Case report: We presented a 56-year old male with acute inferoposterior ST segment elevation myocardial infarction (STEMI) related to very late stent thrombosis, 9 years after BMS implantation, despite antithrombotic therapy. Thrombus aspiration was successfully performed followed by percutaneous coronary intervention (PCI) with implantation of DES into the pre-viously implanted two stents to solve the in-stent restenosis. Conclusion: Very late stent thrombosis, although fortu-nately very rare, not completely understood, might cause myocardial reinfaction, but could be successfully treated with thrombus aspiration followed by primary PCI. Very late ST in the presented patient might be connected with neointimal plaque rupture, followed by thrombotic events.

Stent dislodgement in the distal left main coronary artery and its successful management with balloon crushing technique.

INTRODUCTION: Stent entrapment and dislodgement in the coronary arteries is a rare but potentially fatal complication of percutaneous coronary intervention. Different retrival techniques of dislodged stents have previously been reported with high success rate but all of them are time-consuming, so as not quite useful in hemodinamically unstable patient. CASE REPORT: A 59-year old female patient with acute ST-elevation myocardial infaction of anterior wall was admitted for primary percutanous coronary intervention. Unexpectedly, during intervention stent entrapment and dislodgement in the distal left main coronary artery occured followed by occlusive coronary dissection and compromisation of the coronary flow in the left descending coronary artery with a rapid hemodinamic deterioration. In order to reestablish coronary flow as soon as possible, the dislodged unexpanded stent was crushed against the wall with a balloon in the distal left main. It immediately restored coronary flow in the left descending coronary artery and rapidly improved the patients hemodinamics. Intervention was successfuly completed with totally four stents implanted in the left main, the osteoproxymal circumflex coronary artery and the osteo-proxy-medial left descending coronary artery. Later post-interventional hospital course as well as the clinical and angiographic six month follow-up was uneventful. CONCLUSION. This case shows that percutaneous baloon crushing technique can be a safe and effective first option in management of dislodged and unexpanded stent in the left main coronary artery, particularly for a hemodynamically unstable patient.

History of sports medicine in East European countries.

The purpose of this article is to provide a historical background of medicine, science and sports with the focus on the development of modern sports medicine in European countries, with an accent on Eastern European countries that have a long sports medicine tradition. The development of modern sports medicine began at the end of 19th and the beginning of 20th century, and it has been associated with social and cultural changes in the world of medicine, science and sports. Advanced medical knowledge, skills and practices, and the progress of scientific achievements enabled sports people to improve their performance level. Increased popularisation and commercialisation of sports have resulted from urbanization and city lifestyle, leading to the lack of physical activity and increased psychological pressure. In addition, the growing need and interest in sports and successes in professional sports have become a symbol of international recognition and

Reduced sirolimus systemic exposure and improved bioresorbable polymer properties: new allies for the treatment of patients with coronary artery disease.

This prospective, first-in-man, open-label multicenter study sought to assess the pharmacokinetics of sirolimus after Ultimaster drug-eluting stent implantation (coated with sirolimus and bioabsorbable co-polymer) in patients with de novo coronary artery disease (the TCD-10023 PK study). The primary endpoint was sirolimus concentration in peripheral whole blood at 28 days after stent implantation. In addition, safety, tolerability, therapeutic outcome and vasomotor response after stent implantation were studied. Twenty patients were enrolled in the study. Blood samples for the measurements of sirolimus concentration were collected at eight time points during first 48 h, at 7 days and 28 days after stent implantation. Patients underwent 6-month angiographic and up to 12 months clinical follow-up. At 28 days, only two of 20 patients had sirolimus concentrations above lower limit of quantification (20.0 pg/mL). The highest sirolimus blood concentration was 105 pg/mL. The median maximum concentration was 36.8 pg/mL (range 22.9-41.5 pg/mL) for stent 3.0 × 15 mm and 87.2 pg/mL (range 60.0-105.0 pg/mL) for 3 × 28 mm stent. The median systemic exposure, as measured by the area under the time-concentration curve, was 8.3 ng h/mL (range 6.47-28.0 ng h/mL). At 6 months, endothelial function was well preserved, and up to 12 months, there were no signs of sirolimus toxicity nor any other safety concerns. Our results demonstrate that implantation of Ultimaster stent resulted in almost nondetectable sirolimus in blood after 28 days. These findings were translated into exceptional safety profile, without any sign of systemic toxicity.

The influence of bacterial vaginosis on gestational week of the completion of delivery and biochemical markers of inflammation in the serum.

BACKGROUND/AIM: Preterm delivery is one of the most common complications in pregnancy, and it is the major cause (75-80%) of all neonatal deaths. Bacterial vaginosis predisposes to an increased risk of preterm delivery, premature rupture of membrane and miscarriage. In this syndrome normal vaginal lactobacilli, which produce protective H2O2, are reduced and replaced with anaerobic, gram-negative bacteria and others. The aim of this study was to evaluate the influence of bacterial vaginosis on the week of delivery and biochemical markers of inflammation in the serum. METHODS: A total of 186 pregnant women were included into this study, between the week 16 and 19 of pregnancy. In the study group there were 76 pregnant women with diagnosed bacterial vaginosis by the criteria based on vaginal Gram-stain Nugent score and Amsel criteria. In the control group there were 110 healthy women with normal vaginal flora. Ultrasound examination was performed in both groups. Vaginal fluid and blood samples were taken to determine biochemical markers with colorimetric methods. RESULTS: The week of delivery was statistically significantly shorter in the study group and the levels of biochemical markers of inflammation (C-reactive protein and fibrinogen in the serum) were statistically significantly higher in women with bacterial vaginosis comparing to the control group. Also the levels of uric acid and white blood cells in the serum were higher in the study group compared to the control one. CONCLUSION: Our study indicates that the pregnancy complicated with bacterial vaginosis ends much earlier than the pregnancy without it. Also, higher levels of biochemical markers of inflammation in the serum in the study group, similarly to results of other studies, suggest that pathophysiological processes responsible for preterm delivery can begin very early in pregnancy.

The importance of sleep apnea index determination using 24 h ECG analysis in patients with heart rhythm disorders.

BACKGROUND/AIM: A possible cause of malignant heart rhythm disorders is the syndrome of sleep apnea (periodic cessation of breathing during sleep longer than 10 seconds). Recent 24 h ECG software systems have the option of determination ECG apnea index (AI) based on the change in voltage of QRS complexes. The aim of the study was to determine the significance of AI evaluation in routine 24-hour Holter ECG on a group of 12 patients. METHODS: We presented a total of 12 consecutive patients with previously documented arrhythmias and the history of breathing disorders during night. They were analyzed by 24 h ECG (Medilog AR 12 plus Darwin), that is able to determine AI. RESULTS: We presented a case series of 12 patients, 8 men and 4 women, mean age 58.75 years and the average AI 5.78. In the whole group there was a trend of increasing prevalence of complex rhythm disorders with increasing of AI and increased frequency of arrhythmias in the night phase vs. day phase. CONCLUSION: Determination of AI using routine long term (24 h) ECG analysis is important because sleep apnea can be successfully treated as an etiological or contributing factor of arrhythmias.

[Coronary angiography through ipsilateral ulnar approach in a patient with small-diameter radial artery].

INTRODUCTION: Coronary procedures cannot be completed in 5-15% of cases through initially used radial artery approach due to frequent radial artery anomalies and vasospasm. In these cases, the ulnar artery approach could be the safe and effective alternative wrist approach. CASE REPORT: A 60-year-old patient with stable angina pectoris, hypertension, dyslipidaemia and positive endurance test was admitted to our hospital for coronary angiography. Due to the backbone pains which also made prolonged lying in bed very uncomfortable and painful, we opted for the wrist approach (standard radial approach) after both modified Allen's tests had been performed, which gave the positive result. After sheath insertion into the right radial artery and unsuccessful advancement of the guidewire and the catheter, we performed the right forearm angiography, which revealed that the right radial artery had a small diameter and the right ulnar artery was the dominant one. Afterwards, the right ulnar artery was cannulated successfully and the coronary angiography was performed through this approach. Both sheaths were removed simultaneously immediately after the procedure and hemostasis was secured by the compression with two Terumo-bands over the puncture sites without any complications. The pulses of both arteries were checked regularly over the next 24 hours and they remained normal. A day after the procedure, the control Doppler-ultrasound check-up was performed and it confirmed the normal flow in both cannulated arteries. One-month follow-up was uneventful, and the patient did not experience any ischemic symptoms of the hand. CONCLUSION: This case is the proof that the ipsilateral ulnar approach can be a safe and effective alternative approach in patients with positive Allen's test after the failure of initial radial attempt in cases where femoral approach should be avoided or the wrist approach should be maintained.

Forearm approach for percutaneous coronary procedures.

This article gives contemporary review on the forearm approach for percutaneous diagnostic and interventional coronary procedures. Advantages and disadvantages as well as practical issues and current controversies regarding both radial and ulnar artery approach are discussed throughout the paper. Having in mind advantages of forearm approach in terms of safety and comfort over the traditional femoral approach, as well as the rapid development of invasive technology in the past years, it will probably become the default vascular approach for all percutaneous coronary procedures in the near future.

Rapidly vanishing lung pseudotumor in a patient with acute bilateral bronchopneumonia.

INTRODUCTION: Rapidly vanishing lung pseudotumor (phantom tumor) refers to the transient well-demarcated accumulation of pleural fluid in the interlobar pulmonary fissures. Most frequently their appearance is associated with congestive heart failure, but also other disorders like hypoalbuminemia, renal insufficiency or pleuritis. Its rapid disappearance in response to the treatment of the underlying disorder is a classical feature of this clinical entity. CASE REPORT: A 47-year-old woman, chronic smoker with symptoms of shortness of breath, orthopnea, chills, cough, weakness and the temperature of 39.2 degrees C was admitted to our hospital. A posteroanterior chest X-ray revealed cardiomegaly with the cardiothoracic ratio of > 0.5, blunting of both costophrenic angles and an adjacent 6 x 5 cm well-defined, rounded opacity in the right interlobar fissure. Transthoracic 2-dimensional echocardiography demonstrated left ventricular hyperthrophy with a systolic ejection fraction of 25% and moderate mitral regurgitation. The patient's symptoms resolved rapidly after diuresis, and repeated chest X-ray four days later showed that the right lung opacity and pleural effusions had vanished. CONCLUSION: The presented case underlines the importance of the possibility of vanishing lung tumor in patients with left ventricular failure and a sharp oval lung mass on the chest X-ray. This is the way to avoid incorrect interpretation of this finding causing additional, unnecessary, costly or invasive imaging, interventions and drugs.

[Electrocardiographic specificities in athletes].

INTRODUCTION: The use of electrocardiogram in athletes as a routine screening method for diagnosing potentially dangerous cardiovascular diseases is still an issue of debate. According to the guidelines of the European Society of Cardiology, the recording of electrocardiogram is necessary in all athletes as a screening method, whereas the guidelines of the American Heart Association do not necessitate an electrocardiogram as a screening method and they insist on detailed personal and family history and clinical examination. CLASSIFICATION OF ELECTROCARDIOGRAM CHANGES IN ATHLETES: According to the classification of the European Society of Cardiology, electrocardiogram changes in athletes are divided into two groups: a) usual (physiological) that are connected with training; b) unusual (potentially clinically relevant) that are not connected with training. SUDDEN CARDIAC DEATH IN ATHLETES: The most frequent causes include hypertrophic cardiomyopathy and congenital coronary artery anomalies, while others may be found only sporadically at autopsy. Physiological electrocardiogram changes are frequent in asymptomatic athletes and they do not require further assessment. They include sinus bradycardia, atrioventricular blocks of I and II degree--Wenkebach, isolated increased QRS voltage, incomplete right bundle branch block and early repolarization. Potentially pathological electrocardiogram changes in athletes are not frequent but they are alarming and they urge further assessment to diagnose the underlying cardiovascular disease as well as the prevention of sudden cardiac death. They include: T wave inversion, ST segment depression, complete right or left bundle branch block, atrial pre-excitation syndrome-WPW, long QT interval, short QT interval, Brugada like electrocardiogram finding. CONCLUSION: Introduction of electrocardiogram recording into the screening protocol in athletes increases the sensitivity of evaluation and may help to discover asymptomatic cardiovascular diseases that may cause sudden cardiac death. Special attention and further assessment are required when the above potentially pathological electrocardiogram changes are found in athletes.

[Cardiovascular diseases during pregnancy and delivery]. / Kardiovaskularna oboljenja tokom trudnoce i porodaja.

INTRODUCTION: Nowadays, cardiovascular diseases are the leading cause of maternal morbidity and mortality in the current obstetric practice. PHYSIOLOGICALLY ADAPTED MECHANISMS OF THE CARDIOVASCULAR SYSTEM IN PREGNANCY: It is normal that during pregnancy some physiological adaptive changes of the cardiovascular system occur and they may contribute to the deterioration of the clinical cardiac status of a patient with preexisting or acquired cardiovascular disease. The most prominent adaptive mechanisms include the increase of circulating blood volume, decrease of peripheral vascular resistance and decrease of plasma colloid-oncotic pressure. MOST FREQUENT DISEASES OF THE CARDIOVASCULAR SYSTEM IN PREGNANCY: Due to these changes, pregnant women are prone to tachycardia, palpitations and peripheral edema. Maternal counseling is obligatory for each pregnant woman in order to decrease the maternal morbidity and mortality. The most important predictors of maternal mortality for pregnant women with cardiovascular diseases are severity of pulmonary hypertension, hemodynamic significance of valvular lesion, cyanosis and functional status in heart failure. Cardiovascular diseases in pregnant women may be congenital or acquired. The most frequent congenital cardiac diseases are atrial and ventricular septal defects as well as persistent ductus arteriosus. These diseases are mainly diagnosed and corrected before the pregnancy, or left untreated if hemodynamically insignificant. The most frequent acquired cardiovascular diseases during pregnancy include arrhythmias, ischemic heart disease, rheumatic mitral stenosis and insufficiency, arterial hypertension and aortic dissection. CONCLUSION: In all cases of pregnancy associated with cardiovascular diseases, early recognition of cardiovascular disease is crucial, as well as correct diagnosis and referral to a tertiary centre equipped for a multidisciplinary approach of specialists experienced in high-risk pregnancies and deliveries in order to prevent maternal mortality.

United in prevention-electrocardiographic screening for chronic obstructive pulmonary disease.

CONFLICT OF INTEREST: NONE DECLARED. INTRODUCTION: P-wave abnormalities on the resting electrocardiogram have been associated with cardiovascular or pulmonary disease. So far, "Gothic" P wave and verticalization of the frontal plane axis is related to lung disease, particularly obstructive lung disease. AIM: We tested if inverted P wave in AVl as a lone criteria of P wave axis >70° could be screening tool for emphysema. MATERIAL AND METHOD: 1095 routine electrocardiograms (ECGs) were reviewed which yielded 478 (82,1%) ECGs with vertical P-axis in sinus rhythm. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history and pulmonary function tests. CONCLUSION: Electrocardiogram is very effective screening tool not only in cardiovascular field but in chronic obstructive pulmonary disease. The verticality of the P axis is usually immediately apparent, making electrocardiogram rapid screening test for emphysema.

Analysis of electrocardiogram in chronic obstructive pulmonary disease patients.

INTRODUCTION: Chronic obstructive pulmonary disease is the fourth leading cause of mortality worldwide. It is defined as a persistent airflow limitation usually progressive and not fully reversible to treatment. The diagnosis of chronic obstructive pulmonary disease and severity of disease is confirmed by spirometry. Chronic obstructive pulmonary disease produces electrical changes in the heart which shows characteristic electrocardiogram pattern. The aim of this study was to observe and evaluate diagnostic values of electrocardiogram changes in chronic obstructive pulmonary disease patients with no other comorbidity. MATERIAL AND METHODS: We analyzed 110 electrocardiogram findings in clinically stable chronic obstructive pulmonary disease patients and evaluated the forced expiratory volume in the first second, ratio of forces expiratory volume in the first second to the fixed vital capacity, chest radiographs and electrocardiogram changes such as p wave height, QRS axis and voltage, right bundle branch block, left bundle branch block, right ventricular hypertrophy, T wave inversion in leads V1-V3, S1S2S3 syndrome, transition zone in praecordial lead and QT interval. RESULTS: We found electrocardiogram changes in 64% patients, while 36% had normal electrocardiogram. The most frequent electrocardiogram changes observed were transition zone (76.36%) low QRS (50%) and p pulmonale (14.54%). Left axis deviation was observed in 27.27% patients. CONCLUSION: Diagnostic values of electrocardiogram in patients with chronic obstructive pulmonary disease suggest that chronic obstructive pulmonary disease patients should be screened electrocardiographically in addition to other clinical investigations.

[Thromboembolic complications during pregnancy and delivery].

INTRODUCTION: Venous thromboembolism is one of the leading cause of maternal mortality worldwide. The incidence of venous thromboembolism is estimated at 0.76 to 1.72 per 100.000 pregnancies which is four times as great as the risk in nonpregnant women. The purpose of this article is to raise awareness of this frequent problem in pregnancy and provide a practical approach for the diagnosis, management, and prevention of venous thromboembolism during pregnancy and delivery. RISK FACTORS: A number of risk factors for the development venous thromboembolism have been identified. The two most important risk factors for venous thromboembolism in pregnancy are thrombophilia and previous venous thromboembolism. Deep venous thrombosis in the majority of cases occurs in the lower extremities and pelvis. DIAGNOSIS: As the clinical diagnosis of venous thromboembolism is unreliable, the women who are suspected of having deep venous thrombosis or pulmonary embolism should be examined promptly using imaging diagnostics. The first diagnostic method is Doppler ultrasound. Where available, individual authors recommend magnetic resonance venography, pulmonary angiography or computed tomography. THERAPY: Unfractionated heparin or low-molecular-weight heparin has a central place in the prevention and treatment of venous thromboembolism in pregnancy because they do not pass through the placenta, thus avoiding the risks likely to be induced by warfarin. The prevention of venous thromboembolism must focus on the patients known to be at high risk bearing in mind that the recommendations for prophylaxis, even in high-risk patients, are based on the limited data.

[Percutaneous coronary interventions without on-site cardiac surgical backup]. / Perkutane koronarne intervencije bez "on-site" "kardiohirurske potpore.

Percutaneous coronary interventions are now, three decades after the first balloon angioplasty of the coronary arteries, safe, effective, and most commonly applied method of myocardial revascularization. The first percutaneous coronary intervention without "on-site" cardiac surgery began at the beginning of the nineties of the twentieth century, thanks to the improvement of techniques and materials used for these procedures, as well as the need to make available to citizens in remote areas modern and effective therapy. However, today, after nearly twenty years of application of percutaneous coronary interventions in facilities without cardiac surgery this issue remains controversial and unresolved. So despite the existence of a large number of interventional cardiology centers without "on-site" cardiac surgery in a large number of countries in which they performed a significant number of elective and primary interventions, the official guidelines of the associations for percutaneous coronary interventions still does not recommend implementation of interventions without the existence of "on -site" cardiac surgery. But, recently the focus shifts from the questions about presence of "on-site" cardiac surgery in the direction of defining criteria for performing percutaneous coronary interventions according to the highest standards regardless of the existence of "on-site" cardiac surgical backup. This review article gives the current view on current attitudes about the organization and implementation of percutaneous coronary interventions in facilities without cardiac surgical backup.