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tool of interest to those who primarily engaged in research. IVUS since then became a resource for true luminal and vessel wall Histo-pathological definitions that provided invaluable details. However since the era of good old balloon angioplasty the role of IVUS remained limited to certain applications that included among others angiographic borderline lesions, limited dissections, ambiguous angiographic findings, calcifications and to a lesser extent thrombi. The era of Drug Eluting Stenting (DES) brought additional challenges to modern Per-cutaneous Coronary Interventions (PCI) including issues of Stent sizes and deployment pressures, issues of Stent mal-apposition acute or acquired and Geographic miss. Many of these concerns remained under estimated until we were shocked with the scare of stent thrombosis early late or very late by 2006. The role of IVUS hence became much more contributing and set additional standards of Stent deployment techniques; Of particular importance, the various niche applications like Left Main, Bifurcational, Osteal Stenting and increasing off-label applications of long overlapping stents. IVUS as well enhanced our ability to define causes of stent failures including stent fractures, other stent deformities and malappositions. More recently IVUS introduced forward imaging catheters that are likely to enhance the safety and success of Chronic Total Occlusion Interventions. In addition to grey scale IVUS the introduction of Histo-Pathological simulations using Virtual Histology (VH) and more recently i-map technology is increasingly becoming a niche application for detecting vulnerable plaque providing better definition of Thin Cap Fibro Atheroma (TICFA) that emerged as potential cause of Acute Coronary Syndromes (ACS) and Stent failure when associated with geographic miss. With more outcome trials and emerging additional therapies VH-IVUS is likely to provide An emerging strategy of potential remedial approaches for Vulnerable plaque including lesion pacification whether by intensive medical therapy or possibly Stenting.

SHA 043. Aneurysmal dilatation of the main pulmonary artery and pseudoaneurysm of the right pulmonary artery after arterial switch operation for TGA