Interventional Cardiologist
Irvine, CA
Joined March 2009
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#STEMI & cardiac arrest in ED —> Impella —> LM trifurcation PCI (T stenting)
Aspiration of large mobile thrombi associated with Watchman Flx implanted a year ago; patient presented with embolic stroke. Flash catheter used from Penumbra. Easy to aspirat the free material; left organized material on surface of device behind.
#ICE image of @PenVascular Flash cath aspirating large #Tricuspid valve #vegetation; IJ vein approach.
Variable depth of implant in TAV-in-TAV in different patients to avoid significant leaflet overhang. Target node 6 or 5 of Evolut #TAVR
Revascularization of #CTO of popliteal artery through primary pedal access #TAMI and using drug coated balloon angioplasty #CLIFighters
Our case series of inter/high risk acute PE pts treated w low-dose tPa infusion through peripheral IV (rather than CDT)!!might be as effective & needs less resources. 5 mg tPa IV bolus —> infusion 2 mg/hr for 10 hr (+ Heparin 500 U/H) #PERT #EHJcasereports academic.oup.com/ehjcr/artic…
Challenging (but rewarding) two #Mitraclip cases on last clip day; first secondary MR with severely restricted P2P3 & second with primary MR with P3 prolapse in non-surgical patient.
#coiling of large coronary #fistula from septal branch of LAD to PA with extreme angulations and causing anterior ischemia; supercross microcath & 3 Azur CX coils did the job. #RadialFirst
I have had 3 cases so far with #Synergy #Megatron stent balloon delivery system getting stuck at the tip of the 6 Fr guide and had to pull everything out together; not sure if others are experiencing this?! Mine were all with 4.5 and 5.0 mm stents @bostonsci #RadialFirst
#VIV #TAVR Evolut FX 26 in a 23 trifecta…predictable & stable release. 11 mmhg final gradient & no AI. The gold markers are also a nice addition to confirm commissure alignment. @RachelRN85 @katie_maybanks
Is intra-procedural #Heparin needed during #BAV? I did BAV today on a pt admitted with UGI bleed and didn’t not use #Heparin. A recent small RCT looked at that & showed that it is safer not to use #Heparin with no increased ischemic events! #CardioTwitter sciencedirect.com/science/ar…
Prohibitive risk pt in the 70s presents w acute HF + #SCAI shock Class B —> acute MR secondary to severe prolapse + flail P2. Treated with 2 XTW. Mild residual MR & gradient of 5 mmhg at HR of 70bpm #TEER #Mitraclip
#CLI Resting foot pain of 3-4 weeks duration —> Popliteal artery #embolus fully aspirated with 2 passes with @PenVascular Lightning CAT7 #CLIfighters
Worst case of #SCAD i have seen! Young lady with prior hx inf STEMI & #SCAD of RCA few months ago present with ant-lat STEMI (EKG 👇) -> #SCAD of LM, LAD & LCx -> V fib arrest in cath lab -> Impella -> Emergent CABG -> Excellent recovery! #radialfirst #cardiotwitter #MedTwitter
Lowest LM height I have seen! #ViV #TAVR Trifecta 21 valve with LM height at 0 mm!! VTC at 6 mm & STJ at 17 mm. Treated with Evolut Pro 23 mm. No complications and gradient < 15 mmhg. #CardioTwitter @drpierrenassar – at Cedar Rapids, IA
#CTO of left #CIA treated with 9 mm SES. Wasn’t able to wire from above (brachial access); wired intraluminal successfully from retrograde CFA access. #CLIFighters #cardiotwitter – at Lebanon