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A Palindrome is a phrase that reads the same forwards and backwards. TAVR VIV TAVR is a Palindrome that we will see more onwards. New TAVR valve is implanted inwards. Old TAVR valve stays outwards …

Ruptured papillary muscle as shown on TEE. There are 2 papillary muscles: posteromedial and anterolateral. Which one is more susceptible to ischemia/rupture and why ?

Midnight Shenanigan … Critical distal left main STEMI in an anomalous “Right Main Coronary Artery” originating from the right coronary cusp, requiring JR4 guide to perform PCI through … Also, one can notice the unusually obtuse angle between the LAD & circumflex arteries.

When you’re called-in for a STEMI & cardiogenic shock 3 AM in the morning and this is the first thing you see in the Cath lab as you walk in, you know you have all the power in the world on your side. I don’t know any woman alive who isn’t courageous. Happy International

Sometimes troubles come in pairs …

“Medicine heals doubts as well as diseases …” 40-year-old woman with mechanical mitral valve presents with severe heart failure. Obstructive mechanical valve thrombosis is diagnosed. She was turned down for surgical intervention and recovered well with tPA infusion.

“Teamwork makes the dream work …” Less than a year ago; and together, we started a WATCHMAN program. Today, we hit the 50th implanted WATCHMAN milestone. Thank you, CHRISTUS for your support.

Not all mitral valve regurgitation is systolic. There is DIASTOLIC mitral regurgitation. Here is an example: 2:1 AV block - When the atrium relaxes after a non-conducted P-wave, transmitral valve gradient reverses, as the atrium contracted against full LV with high pressure.

Innovation in medicine is born when a new technology, an old problem, and a big idea intertwine. Innovative case of Intravascular Shockwave Lithotripsy of proximal left subclavian artery, curing severe vertebrobasilar insufficiency from subclavian steal syndrome. Shockwave Medical

72-year-old woman comes with cardiogenic shock & blue left hand. IMPELLA placed then removed. A tissue is attached to IMPELLA pigtail. Diagnosis? Catastrophic antiphospholipid syndrome (CAPS): rare, life-threatening form of APS characterized by severe thrombotic complications.

“Go Over, Go Under, Go Around, or Go Through; But Never Give Up Sparing a Limb From Amputation ”… “Up & Over” in Endovascular Interventions is not only crossing to the contralateral extremity, but can also be ipsilateral as well.

The scrub tech is asking before pacemaker implantation: - “Do you get access before you make the pocket?” I answered: - “Yes. Because once in a blue moon, you have complete venous obstruction. A pocket should only be formed when access to the heart is done”. Few minutes later:

Methhemoglobinemia (MetHeb) is not a Myth. 46-year-old woman undergoes complex coronary Intervention and another cardiac procedure. Final ACT blood sample was dark-chocolate color as shown. What procedure has been performed prior to coronary intervention? What is the antidote?

Rest in peace, Dr. Alain Cribier. Your legacy in Cardiovascular Medicine and Structural Heart Disease lives on. Dr. Cribier performed the first BAV in 1986, first mitral balloon commissurotomy in 1995, and first TAVR in 2002. We all are your lifelong students.

I highly recommend this structural fellowship. I trained there and it was one of the best training opportunities there is. It’s a hidden gem. DM me if you have any questions.

Ascension Borgess Hospital in Michigan is offering one year combined Structural/CHIP/CTO Fellowship for 2025-2026. Must be ABIM eligible or certified in Interventional Cardiology. Applicants can reach out to [email protected]. Very highly recommended. I trained there!