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Early recanalisation of an occluded coronary artery to achieve timely myocardial reperfusion is the main goal of treatment of myocardial infarction during the acute phase. Successful recanalisation has generally been defined as the angiographic demonstration of early and complete (TIMI-3 flow) patency of the infarct related artery; however, angiography has serious limitations for judging of the efficacy of reperfusion treatment.1 In particular, patients with a widely patent epicardial coronary vessel often demonstrate lack of adequate myocardial perfusion, most likely because of microvascular injury. This “no-reflow” phenomenon was first described in 1974 by Kloner et al in an animal model,2 and observed in man in 1992 by Ito et al using intracoronary myocardial contrast echocardiography (MCE) performed during primary angioplasty (PTCA) for acute myocardial infarction.3 Taking advantage of the access to the coronary circulation offered during primary PTCA, this technique relies on direct intracoronary injection of contrast agents containing microbubbles, often using simple sonicated radio-opaque dyes. Simultaneous echocardiography allows opacification of the perfused myocardium through reflection of ultrasonic energy by the air containing microbubbles located in the myocardial microvasculature (fig1).