The Murmur Pod

MurmurMD
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The Murmur Pod is hosted by Dr. Aidan Raney III and Dr. Joe Walsh. Specializing in interventional cardiology, they explore happenings in the cardiology and medical communities, discuss interesting cases, review new technology, and more. This podcast is presented first in the MurmurMD App! Work in the cath lab? Reach out to join the private community there!

  1. 2d ago

    Everything You Need to Know About ICE Guided TTVR with Dr. Sameer Gafoor

    Transcatheter tricuspid valve replacement is quickly becoming a real option for patients with severe symptomatic TR, but the decision-making is still nuanced. In this MurmurMD discussion, Dr. Aidan Raney speaks with Dr. Sameer Gafoor, about a Septuagenarian female with severe non-rheumatic tricuspid regurgitation, NYHA class III symptoms, prior mechanical mitral valve replacement, persistent AFib on warfarin, prior stroke, EF around 44%, RV dilation, moderately reduced RV function, TAPSE 1.1, and severe TR. The case focuses on why Dr. Gafoor's team favored transcatheter tricuspid valve replacement over edge-to-edge repair, how they approached CT and echo sizing, and how they moved their program from TEE-guided TTVR toward ICE-only TTVR, including a pathway from general anesthesia with TEE and ICE to conscious sedation with ICE. The discussion also covers key questions every TTVR program has to answer: surgical risk scoring, RV dysfunction, anticoagulation, pacemaker risk, working room, valve sizing, procedural imaging, fluid status matching, and what patients should expect after intervention. KEY TOPICS • Severe symptomatic non-rheumatic TR • TTVR vs edge-to-edge repair decision-making • Surgical risk vs tricuspid-specific risk scores • RV dysfunction, TAPSE, and when to say no • CT sizing vs TEE and ICE measurements • Annular and basal RV oversizing • Working room, RA height, RV height, and RV depth • ICE-only TTVR workflow development • Anchor position, commissures, and deployment assessment • Matching fluid status between CT and procedure • Anticoagulation requirements after TTVR • Pacemaker risk and lifetime management questions 🔔 Subscribe for more insights from interventional experts and real-world program builders.📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA CHAPTERS 00:00 – Introduction: TTVR case from Swedish Hospital 00:32 – Patient presentation: severe TR, AFib, MVR, stroke, and RV dysfunction 01:22 – Surgical consult, CT, TEE, and risk scoring 02:52 – Choosing intervention: repair vs replacement 03:52 – CT sizing, TEE discrepancy, and oversizing 04:53 – Working room: RA height, RV depth, and delivery space 05:35 – Moving from TEE-guided to ICE-only TTVR 07:54 – ICE setup, MPR views, and valve orientation 09:11 – Deployment assessment and anchor position 10:34 – Final result and key lessons learned 12:06 – Q&A: surgical risk scores and tricuspid-specific tools 13:56 – RV dysfunction and when to avoid TTVR 15:35 – Post-procedure support and Swan discussion 15:59 – ICE workflow as primary imaging strategy 17:28 – Closing thoughts #TTVR #TricuspidValve #TricuspidRegurgitation #StructuralHeart #CardiacImaging #ICE #TEE #ValveReplacement #RightHeartFailure #TranscatheterValveReplacement #MurmurMD

    Everything You Need to Know About ICE Guided TTVR with Dr. Sameer Gafoor

  2. Aug 3

    Tricuspid Regurgitation: Imaging, Patient Selection, and the Repair-First Strategy

    Tricuspid regurgitation is no longer just a disease managed with diuretics and observation. In this MurmurMD discussion, Matt Summers is joined by Dr. Josh Cohen, structural heart imaging director, to discuss the rapid growth of tricuspid valve intervention, the central role of imaging, and how teams are thinking through repair versus replacement strategies. The conversation focuses on why TR has become such a major structural heart focus, how common and clinically impactful moderate-to-severe TR really is, and why imaging — especially 3D multiplanar reconstruction — is critical for deciding whether a patient should undergo edge-to-edge repair or be evaluated for transcatheter tricuspid valve replacement. They also discuss the shift from treating advanced screen-fail patients to identifying patients earlier in the disease course, the safety profile of TriClip, the evolving role of EVOQUE, and why tricuspid programs need a structured workflow around volume optimization, TEE assessment, RV function, pulmonary pressures, and CT screening. KEY TOPICS • Why TR is becoming a major structural heart focus • The clinical burden of moderate-to-severe TR • Functional, lead-associated, and degenerative TR • Why isolated surgical TR outcomes have been challenging • Growth of TriClip, EVOQUE, and other tricuspid therapies • 3D MPR and imaging-guided procedural planning • Repair-first thinking in frail or advanced TR patients • Repair vs replacement decision-making • RV remodeling, symptoms, and heart failure admissions • Volume optimization before intervention • TEE as the pivot point for repair vs TTVR screening 🔔 Subscribe for more insights from interventional experts and real-world program builders. 📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687 📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA CHAPTERS 00:00 – Introduction: tricuspid intervention and imaging focus 03:10 – Why 3D imaging changes tricuspid planning 05:12 – How common and impactful TR really is 08:07 – Functional, lead-associated, and degenerative TR 09:45 – Why isolated surgical TR has been difficult 10:46 – Repair, replacement, and emerging device options 12:24 – TriClip, EVOQUE, safety, and patient selection 13:45 – Why a repair-first strategy may make sense 16:17 – Symptoms, RV remodeling, and heart failure reduction 18:23 – Real-world program experience and outcomes 20:26 – Workflow: inpatient consults, volume status, and TEE 22:25 – Choosing repair vs CT screening for TTVR #TricuspidValve #TricuspidRegurgitation #StructuralHeart #TriClip #EVOQUE #TTVR #CardiacImaging #TEE #3DMPR #HeartFailure #ValveDisease #MurmurMD

    Tricuspid Regurgitation: Imaging, Patient Selection, and the Repair-First Strategy

  3. Jul 20

    LV Pacing for TAVR: Why SoloPace May Simplify Deployment and Improve Safety

    LV pacing during TAVR can simplify workflow, reduce reliance on RV temporary pacing, and potentially avoid one of the most dreaded complications in the cath lab: RV perforation and tamponade. In this MurmurMD discussion, Dr. Aidan Raney speaks with Dr. Thom Dahle, Director of the Valvular Heart Disease Program at St. Cloud Hospital, about LV pacing best practices and early experience with the SoloPace System. The conversation reviews why LV pacing may offer advantages over traditional RV pacing, how operators can improve capture and wire positioning, and how a dedicated pacing platform may reduce variability during balloon valvuloplasty and valve deployment. The discussion includes a live TAVR workflow using SoloPace, highlighting practical features such as capture check, operator-controlled pacing algorithms, backup pacing after deployment, and simplified room setup. KEY TOPICS • Why operators are moving from RV pacing to LV pacing • RV pacing lead perforation and tamponade concerns • Easy TAVI data and LV pacing rationale • LV wire positioning and capture best practices • Why capture can initially look “wonky” during LV pacing • Using hemodynamics to confirm effective capture • SoloPace Fusion wire as a workhorse TAVR wire • Capture check and automated pacing workflows • Balloon-expandable vs self-expanding pacing algorithms • Backup pacing after valve deployment • How SoloPace may improve lab efficiency and reduce communication errors 🔔 Subscribe for more insights from interventional experts and real-world program builders. 📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687 📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Why LV pacing may be safer and more efficient 00:57 – LV pacing rationale and Easy TAVI data 02:23 – Traditional LV pacing setup and capture challenges 04:11 – Wire positioning best practices in the LV 06:31 – St. Cloud’s experience moving toward SoloPace 09:05 – SoloPace Fusion wire and dedicated system setup 12:00 – Live case workflow and LV pacing setup 16:00 – Capture check, safety features, and valve deployment prep 20:19 – Fusion wire connection and automated backup pacing 22:11 – TAVR deployment using SoloPace 25:05 – What happens if heart block occurs after deployment? 27:04 – Pacing algorithms for balloon-expandable and self-expanding valves 29:28 – Efficiency, room setup, and final impressions #TAVR #LVpacing #SoloPace #StructuralHeart #AorticStenosis #ValveReplacement #CathLab #InterventionalCardiology #MurmurMD

    LV Pacing for TAVR: Why SoloPace May Simplify Deployment and Improve Safety

  4. Jul 18

    Complex TriClip Cases, Leads, and TTVR Strategy with Dr. Cohen and Dr. Summers

    Tricuspid intervention is not just a device procedure, it is an imaging-driven, two-person operation. In this MurmurMD case discussion, Dr. Summers and Dr. Cohen walk through a series of tricuspid valve repair and replacement cases that highlight how procedural success depends on imaging precision, anatomy recognition, fluoroscopy correlation, and real-time teamwork between the imager and interventionalist. KEY TOPICS • Why tricuspid repair is fundamentally imaging-driven • Imager and interventionalist collaboration during TriClip • Using TEE, 3D MPR, transgastric views, ICE, and fluoroscopy together • Clip strategy near the anterior-septal commissure • Leadless pacemakers near the septal leaflet • ICD and CS lead interaction with the tricuspid valve • Lead repositioning/corralling before clipping • Lead extraction followed by persistent torrential TR • Two-clip strategies that create an annuloplasty-like effect • When TTVR may be favored over repair • TTVR planning around leadless devices, flail leaflets, wire position, and leaflet capture 🔔 Subscribe for more insights from interventional experts and real-world program builders. 📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687 📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Why tricuspid repair is an imaging procedure 04:40 – Case 1: TriClip with a leadless pacemaker 10:00 – How TriClip reconstructs the tricuspid valve 11:20 – Case 2: CRT leads, lead interaction, and clipping strategy 19:14 – Case 3: Torrential TR after lead extraction 27:12 – Fluoroscopy, parallax, and clip orientation 28:01 – Case 4: Acute leaflet flail and TTVR planning 36:10 – Final takeaways on imaging, leads, and tricuspid strategy #TricuspidValve #TriClip #TTVR #TricuspidRegurgitation #StructuralHeart #CardiacImaging #TEE #ICE #LeadRelatedTR #ValveRepair #InterventionalCardiology #MurmurMD

    Complex TriClip Cases, Leads, and TTVR Strategy with Dr. Cohen and Dr. Summers

  5. Jul 8

    Valve Clinics, Early Discharge, and Patient-Centered Care: The Clinician Role Explained

    Successful valve programs are not built by procedures alone. In this MurmurMD discussion, Dr. Andrei Pop speaks with Sandra Lauck, a valve specialist in British Columbia at the Center for Heart Valve Innovation, about the essential role of valve program clinicians in building efficient, patient-centered structural heart programs. The conversation explores why the term “coordinator” often undersells the role, how these clinicians support patients and families from referral through discharge, and why their work is central to timely treatment, early discharge, communication, shared decision-making, and program growth. KEY TOPICS • Why valve program clinicians are not simply “coordinators” • Clinical triage, urgency assessment, and patient education • Early discharge planning and shared decision-making • Benchmark, same-day discharge, and patient expectations • Training, competencies, and career development for valve clinicians • Standardized pathways, single referral systems, and avoiding silos • Moving from procedure-focused clinics to disease-centered valve programs • The future of nurse-led research and integrated mitral/tricuspid care A practical guide for anyone building, optimizing, or expanding a structural heart valve clinic. 🔔 Subscribe for more insights from interventional experts and real-world program builders. 📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687 📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Introduction: Sandra Locke and the valve clinician role 01:08 – Why successful valve clinics depend on clinicians 02:34 – From coordinator to clinical heart-team member 04:02 – Patient expectations, discharge planning, and trust 06:05 – Three pillars: clinical care, communication, and program leadership 08:11 – Training, competencies, and growing the role 12:32 – How valve clinicians affect length of stay and efficiency 15:17 – Avoiding silos across competing valve teams 18:43 – Referral delays and the case for automatic valve clinic pathways 20:03 – Valve clinic vs TAVR clinic 21:45 – Moving toward disease-centered valve programs 23:31 – Longitudinal valve care and proactive planning 24:33 – What comes next: research, staffing, and integrated valve care #StructuralHeart #ValveClinic #TAVR #HeartTeam #ValveProgram #Benchmark #NurseLedCare #PatientCenteredCare #AorticStenosis #MurmurMD

    Valve Clinics, Early Discharge, and Patient-Centered Care: The Clinician Role Explained

  6. Jul 1

    Solutions for Complex Reverse CART: IVL and Subintimal Calcium Modification

    What do you do when a calcified RCA CTO case stalls, your equipment will not deliver, and conventional reverse CART strategy becomes difficult? In this MurmurMD discussion, Dr. Chris Brown and Dr. Eric Rothstein review a challenging CTO case involving a 57-year-old patient with five years of angina, a large ischemic RCA territory, prior LAD treatment without symptom improvement, and a heavily calcified RCA CTO. The case evolves through several classic CTO decision points: upfront ADR consideration, side-branch anchoring, architectural knuckle formation, intralesional ambiguity, retrograde septal crossing, difficulty joining tissue planes, and ultimately the use of intravascular lithotripsy to modify calcified subintimal/extraplaque space and facilitate reverse CART. KEY TOPICS • RCA CTO with long-standing angina and ischemia • Hybrid CTO strategy and switching approaches mid-case • Side-branch anchor technique for guide support • Large architectural knuckle vs small knuckle strategy • Intralesional ambiguity and how to define the vessel course • Retrograde septal crossing strategy • Why guide extension delivery can fail in calcified CTOs • IVL use in the subintimal/extraplaque space • Shockwave to facilitate reverse CART • Trapping, microcatheter delivery, and externalization • IVUS interpretation after CTO crossing • Conservative sizing in the subintimal space • Why IVL may be preferable to atherectomy in this setting 🔔 Subscribe for more insights from interventional experts and real-world program builders. 📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687 📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Key concept: microcatheter delivery and externalization 00:22 – Case introduction 00:44 – Patient presentation: 57-year-old with five years of angina 01:45 – RCA CTO anatomy, J-CTO score, and initial strategy 02:46 – Failed knuckle formation and need for more guide support 03:28 – Side-branch anchor technique in the conus 04:44 – Large architectural knuckle strategy 05:54 – Intralesional ambiguity and CTO decision-making 06:54 – Options: bigger knuckle, BASE, Carlino, or retrograde definition 07:55 – Switching to retrograde strategy 08:57 – Septal surfing and retrograde crossing 11:00 – Retrograde support, guide extension limits, and plaque modification 12:16 – Balloons fail to expand in the subintimal space 14:00 – Shockwave IVL to modify calcified CTO architecture 15:00 – Anchor technique to deliver larger equipment 15:39 – Retrograde wire choice for reverse CART 17:07 – Moving the reverse CART strategy proximally 19:01 – Wiring the guide vs snaring 19:50 – Balloon trapping to deliver the microcatheter 20:50 – Externalization with R350 or RG3 21:13 – IVUS: true lumen, subintimal space, and hematoma 22:10 – Ballooning, stent sizing, and conservative expansion 22:49 – Final IVUS and result 23:27 – Why IVL may be safer than atherectomy in the extraplaque space 24:23 – Closing thoughts and key learning points #CTO #ComplexPCI #IVL #IntravascularLithotripsy #ShockwaveIVL #ReverseCART #RCACTO #CoronaryCalcium #InterventionalCardiology #CathLab #MurmurMD

    Solutions for Complex Reverse CART: IVL and Subintimal Calcium Modification

  7. Jun 29

    TAVR Explant Is Changing: Outcomes, Risk, and the Case for TAVR-First with Dr. Pop and Dr. Fukuhara

    TAVR explant was once viewed as a procedure to avoid almost at all costs. Early national data showed very high mortality, creating fear among both physicians and patients. In this MurmurMD discussion, Dr. Andrei Pop speaks with Dr. Shinichi Fukuhara, from the University of Michigan, about how the field has evolved, and why newer data may change the conversation around TAVR explant, redo TAVR, and lifetime management of aortic stenosis. The discussion explores why TAVR explant outcomes have improved, how patient selection has changed, what the latest STS data suggest, and why isolated TAVR explant may now be far more reasonable in carefully selected patients than many clinicians assume. KEY TOPICS • Why early TAVR explant mortality created fear • Improved outcomes in more recent STS data • Isolated TAVR explant vs more complex explant cases • Tall-frame vs short-frame explant considerations • Why high-volume centers may matter • Hidden surgical findings after valve removal • TAVR-first as a possible strategy in selected younger patients • What a “perfect” index TAVR result should include • Coronary access, commissural alignment, and tissue ingrowth • Why lifetime management requires strong heart-team decision-making 🔔 Subscribe for more insights from interventional experts and real-world program builders. 📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687 📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Introduction: why TAVR explant matters 01:03 – Early STS data and why explant was feared 02:52 – Why outcomes have improved over time 03:57 – Isolated TAVR explant and recent mortality data 06:11 – New STS risk prediction for post-TAVR surgery 07:24 – Tall-frame vs short-frame explant considerations 08:44 – Can TAVR explant outcomes be democratized? 11:16 – Why center experience may matter 12:05 – Unexpected findings after TAVR explant 12:58 – Lifetime management and risk modeling 14:19 – TAVR-first as a possible strategy 15:32 – Which younger patients may fit a TAVR-first approach? 17:25 – What a “perfect” index TAVR result requires 19:04 – Heart-team decision-making 19:19 – Tissue ingrowth, coronary access, and future risk 21:10 – What surgeons see during explant #TAVR #TAVRExplant #StructuralHeart #AorticStenosis #RedoTAVR #LifetimeManagement #HeartTeam #CardiacSurgery #InterventionalCardiology #MurmurMD

    TAVR Explant Is Changing: Outcomes, Risk, and the Case for TAVR-First with Dr. Pop and Dr. Fukuhara

  8. Jun 24

    Unprotected Left Main, Low EF, and No Blood Products: How Much PCI Risk Is Acceptable?

    Some complex PCI cases are difficult because of the anatomy. Others are difficult because the margin for error is almost zero. In this MurmurMD discussion, Dr. Chris Brown and Dr. Christian McNeely walk through a high-risk NSTEMI case involving an elderly Jehovah’s Witness patient with severe multivessel coronary disease, heavily calcified distal left main disease, reduced EF, anemia, elevated filling pressures, and an occluded RCA. The central issue is not just how to treat the lesion, it is how to think through risk when both options are dangerous: surgery is preferred but not feasible, while PCI requires hemodynamic support and large-bore access in a patient who cannot receive blood products. KEY TOPICS • High-risk NSTEMI with severe multivessel disease • Unprotected calcified distal left main disease • Low EF, high EDP, anemia, and occluded RCA • Jehovah’s Witness status and refusal of blood products • Why CABG was not feasible at the time • Impella-supported PCI and large-bore access risk • Counseling when bleeding may be fatal • Limits of current complex PCI risk calculators • Shockwave IVL in the distal left main • Ostial left main recognition and stent positioning • Provisional circumflex strategy • Closure technique after large-bore access • Planning for staged RCA intervention 🔔 Subscribe for more insights from interventional experts and real-world program builders. 📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687 📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA Chapters: 00:00 – Case introduction and risk stratification 00:41 – High-risk NSTEMI and severe multivessel disease 01:33 – Calcified distal left main and limited RCA options 02:20 – Jehovah’s Witness status and why CABG was not feasible 03:02 – Why hemodynamic support was needed 04:30 – Anemia, no blood products, and surgical thresholds 05:15 – Why this anatomy is truly complex 06:34 – Counseling around bleeding risk and large-bore access 08:25 – The need for better complex PCI risk calculators 10:18 – Operator risk tolerance and institutional support 11:44 – Femoral access, Impella support, and high EDP 12:16 – Shockwave IVL and loss of pulsatility 13:30 – LAD/left main stenting with circumflex preservation 14:35 – Ostial left main positioning and cusp view 15:34 – Final optimization and provisional circumflex access 16:25 – Large-bore closure with no bleeding 17:08 – Planning the staged RCA intervention 18:33 – Final thoughts on risk, consent, and complex PCI #ComplexPCI #HighRiskPCI #LeftMainPCI #Impella #MechanicalCirculatorySupport #ShockwaveIVL #CoronaryCalcium #InterventionalCardiology #CathLab #MurmurMD

    Unprotected Left Main, Low EF, and No Blood Products: How Much PCI Risk Is Acceptable?
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About

The Murmur Pod is hosted by Dr. Aidan Raney III and Dr. Joe Walsh. Specializing in interventional cardiology, they explore happenings in the cardiology and medical communities, discuss interesting cases, review new technology, and more. This podcast is presented first in the MurmurMD App! Work in the cath lab? Reach out to join the private community there!

Information

  • Creator
    MurmurMD
  • Years Active
    2025 - 2026
  • Episodes
    62
  • Rating
    Clean
  • Copyright
    © MurmurMD
  • Show Website
    The Murmur Pod

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