Marco Kaldas

@JaeKOh2 @ASE @aae_echo He should tell him : This is a case of severe restrictive cardiomyopathy and the VSD influenced such cath hemodynamics

I haven't posted in a while... but here a technique to repair an anterior MV prolapse with transfer of P2 segment, and patch repair of P2. A technique I have learned from Prof. El Khoury. This is open for discussion. More to come;) @GebrineK

@TrackYourHeart Went into the 3rd Dimension

Gone in seconds. Catastrophe in minutes. Where did it land?

@SVRaoMD @benhibbertMDPhD @TCTMD Great points 👍🏼 With very low event rates on DOACs, even a slightly worse therapy can pass) Margin selection can artificially favor LAAO. Should we accept clinically meaningful excess stroke risk to gain less bleeding?

@benhibbertMDPhD @TCTMD Important trial! My observations - Increase in ischemic stroke, no difference in ICH, event rate less than half of predicted with a relative margin that doesn’t meet non-inferiority (1.66).

CHAMPION AF is out at ACC - (nejm.org/doi/full/10.10…) and there are gonna be some hurt feelings on both sides! Thanks @TCTMD (tctmd.com/news/chaampion…) for the commentary. My thoughts having read the paper a couple of times: 1. LAAO seems to invoke passions in people – I think this study won’t sway either counter party. If you believe in this approach you will be reassured by no increased risk of stroke, reduction in bleeding and the excellent safety profile of the procedure. If you are an LAAO heretic I think you’ll worry about the low event rate – although the absolute differences in stroke/SE maybe approaching clinical irrelevance (1%over three years, 0.3% a year). The differences either way are so small for a patient/clinician this effect isn't going to factor in my decision making. 2. So who won CHAMPION-AF? – patients. I think this solidifies LAAO as an alternative to DOAC. Patients can now meet with their cardiologist and discuss the trade-offs of each strategy. If patients are procedurally oriented they may be willing to accept a potential very small increased risk of stroke/SE to get off medications. Conversely, patients taking DOAC can be reassured that their risk of major bleeds/ICH are comparable to having a device – although they are much more likely to have bleeding events that need medical attention. Both strategies are acceptable and those discussions will really center around patient preference. 3. How does this fit in existing literature? Procedures are not drugs – and device type and procedural hygiene matter. Making sure we minimize complications from both the procedure and post-procedure care are paramount. This continues to improve with device iterations and studies optimizing post-implant medical regimens. CHAMPION proves this is an incredibly safe procedure in the right hands. 4. What comes next? – this sets the stage for important 5 year data. The primary outcome of that is ischemic stroke and systemic embolization. In theory ischemic risk and bleeding risk could continue to diverge. CATALYST will also be set to present – with a similar design but unfortunately an older generation device. LAAOS4 - adding DOAC to Watchman is a compelling hypothesis and we are recruiting! Either way - LAAO is now mainstream and with all therapies patient preference is going to rule the day.

Teaching case/decision making 👉 M. 69 yo with severe AS scheduled for SAVR 📍preop TTE 📍intraop TEE (pre-CPB) 📍no pt’s informed consent about MV surgery Intraop TEE done by a fellow How would you proceed #echofirst @iamritu @NMerke @CASivaram1 @DrRajeshG1 @OungSavly

@fbalex19071 @CASivaram1 @alex1708ander @iamritu @NMerke @DrRajeshG1 @OungSavly It is definitely more than mild look here . Also 3D Mitral shows significant lack of scallops coaptation in systole where the jet originates . Don’t rely on PISA it is less reliable in MVP

@CASivaram1 @alex1708ander @iamritu @NMerke @DrRajeshG1 @OungSavly Okay, on what basis do you say it's definitely more than mild?

Happy Eid ul Fitr - wishing all my muslim friends all the best to their family full of happiness and success for the year ahead

Closure AF “ These findings do not favor the device. They do, however, raise the question of whether the same composite endpoint design—NACE in a noninferiority framework—should continue to be used in LAAO trials. Every "positive" LAAO trial used composites with similar structural biases; the fact that CLOSURE-AF failed despite these biases makes its negative signal more informative, not less. The forthcoming CHAMPION-AF results, using a cleaner endpoint architecture, will provide the first truly interpretable NI test of percutaneous LAAC against DOACs.“

🔍 TGA on TEE – A fascinating echo finding! In (TGA), the aorta arises from the RV and the pulmonary artery from the LV. 🫀 TEE beautifully demonstrates the parallel course of the great arteries instead of the normal crossing pattern.

@drjohnm If the patient is symptomatic with CAC > 100 then Cath May be appropriate. Usually Stress nuclear is the Appropriate test in that setting

BI is correct 👇🏻 A test is a test. The misuse of CAC is on doctors who refuse to accept that the clogged pipe frame of CAD is wrong headed My criticism is with the CAC/anatomy experts for not shutting down the misthink

Worldwide Radiation Dose in Coronary Artery Disease Diagnostic Imaging jamanetwork.com/journals/jama/…

“in patients with only mild increases of cardiac iron, non-contrast T1 mapping showed superior reproducibility as compared to T2* measurements “

🚨Most Muslims train at the WRONG time during Ramadan. 😬 Not because they’re lazy. Because no one explains the physiology. 🕌☪️ As a cardiologist + certified personal trainer, I see the same mistake every year. One simple timing shift can protect your ❤️ AND improve performance. 💪 Reshare! Full breakdown here 👇 dralo.net/blog/ramadan

Whoa! I got to interview @ziadalinyc and learn something now during the interview! During @GisGulf meeting! How cool is that! DYK about AI & IVUS?

Wishing all my muslim friends all the very best for the upcoming month Thank you for your friendship and kindness

VIDEO: Ziad Ali, MD, explains how CCTA has created a major shift in cardiac care at his center. #YesCCT #PCI #CCTA #Cardiology #radiology ow.ly/yt5Z50Yfq9m

@SoveyX 10 yrs ago on a Sunday morning an elderly lady suddenly collapsed , witnessed by a medical personnel who started chest compressions immediately that saved her life . CPR does save lives

Emma Dilley, a student at Dallas Baptist University, helped save a stranger's life in downtown Dallas on Tuesday night. Dilley performed CPR on an unconscious man despite having never done so on a human, before first responders took over medical care. She learned CPR in high school and was happy that her training came in handy. CPR classes save lives and good people still exist! Great job Emma!

Congrats Stefan! Proud of you!! At last our work on LAAO planning with CT is out! @OKhaliqueMD @rooshaparikh @Texas_Heart @bcmhouston @purviparwani @iamritu @DrMarthaGulati @OKhaliqueMD @AmroAlsaid @DrRyanPDaly @Kfarooqi

Can MRI replace the RHC? Commentary on an interesting @JACCJournals paper covered by @Medscape @purviparwani @OKhaliqueMD @rooshaparikh @PragyaRanjan @DrFuisz @SCAI @Babar_Basir @agtruesdell @adityadoc1 medscape.com/s/viewarticle/…

Advocacy WORKS. #ACCLegConf WORKS. @cardiology WORKS. #HeartPAC WORKS. @ACCinTouch member value WORKS. Your voice WORKS. Here's what Congress passed:

In Atrial Functional MR can get “Hamstringing”of posterior MV leaflet due to massive LA dilation;this “atriogenic” leaflet tethering is from displaced posterior annulus onto crest of LV inlet resulting in⬆️in annulopapillary distance restricting leaflet motion #echofirst