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. Iliac CTO Masterclass: Access, IVUS, Re-Entry, IVL, and Stent Strategy with Dr. Jay Mohan and Dr. Sameh Sayfo

    3 DAYS AGO

    Iliac CTO Masterclass: Access, IVUS, Re-Entry, IVL, and Stent Strategy with Dr. Jay Mohan and Dr. Sameh Sayfo

    Iliac CTOs are among the highest-risk, highest-reward procedures in peripheral intervention. In this MurmurMD session, Dr. Jay Mohan joins Dr. Sameh Sayfo to break down their full approach — from diagnosis and CTA planning to crossing strategies, re-entry methods, IVUS, vessel prep, and stent selection. This case-driven conversation is packed with pearls on how to handle complex iliac occlusions safely and predictably. What you’ll learn from this transcript-based discussion: • Why PVR and waveform analysis matter more than ABI alone • CTA essentials: calcium burden, aorto-iliac disease, access planning • Jay’s preferred dual-access setup (radial + ipsilateral femoral) • When to start anti-grade vs retrograde — and how to choose the correct cap • Safe knuckling with microcatheter support through the CTO • How to externalize the wire and complete the case through femoral access • Why “every iliac should be IVUS” • IVL in the iliac system: M5+, L6, Javelin, and how vessel size determines device choice • Covered vs uncovered stents (VBX, ICAST, Lifestream, Visi-Pro) • Why balloon-expandable covered stents dominate TASC C/D and CTO lesions • When to use kissing stents and when to avoid self-expanding at the common iliac ostium • Rescue toolkit: covered stents, bright-tip sheaths, alternative access, balloon tamponade • Why Pioneer re-entry is less common now — and how R2P changed the game A must-watch for operators who want to sharpen their iliac CTO algorithm and device selection. 🔔 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 iliac CTOs are high-risk, high-reward lesions 01:00 – Symptoms, ABI/PVR, waveform interpretation 02:00 – CTA planning: calcium, inflow disease, access strategy 03:00 – Choosing access: radial + ipsilateral femoral 04:00 – Anti-grade vs retrograde crossing strategy 05:00 – Knuckling technique and microcatheter support 06:00 – Re-entry options: R2P vs Pioneer 07:00 – IVUS: why “every iliac should be IVUS” 08:00 – Vessel prep: M5+, L6, Javelin, and when each matters 09:00 – Stent selection: covered vs uncovered, ostial precision 10:00 – Kissing stents and hybrid approaches 11:00 – Rescue toolkit: perforation, sheath size, balloon tamponade 12:00 – Final pearls for early operators #PeripheralIntervention #IliacCTO #IVL #IVUS #Endovascular #ComplexPCI #PeripheralArteryDisease #MurmurMD #VBX #ICAST #R2P #CoveredStents

    25 min
  2. BiPella in Acute MI Shock: When Biventricular Unloading Beats Inotropes

    2 FEB

    BiPella in Acute MI Shock: When Biventricular Unloading Beats Inotropes

    Not all cardiogenic shock after acute MI is left-sided — and treating it like it is can be fatal. In this MurmurMD case discussion, Dr. Chris Brown walks through a young patient with acute MI, progressive shock, and severe right ventricular failure, highlighting how early recognition and biventricular mechanical support (Bipella physiology) stabilized the patient when inotropes and balloon support failed. This transcript-based conversation focuses on real-time decision-making, including: • Differentiating acute occlusion from chronic disease in an MI presentation • Why rising troponins without washout suggested ongoing ischemia • Recognizing RV failure as the primary shock driver • Why balloon pump and escalating inotropes worsened physiology • Early RV unloading with RP support as the first step toward BiPella • Hemodynamic clues that mandated adding LV unloading • Why RV support should precede LV support in evolving BiPella shock • PCI strategy once full biventricular support is established • Renal recovery after unloading both ventricles • Using BiPella as a bridge to recovery, LVAD, or transplant decision-making • Why unloading injured myocardium outperforms pharmacologic stimulation A clear, real-world example of BiPella physiology saving a failing heart when revascularization alone isn’t enough. Chapters: 00:00 – Acute MI with shock: LV vs RV failure dilemma 01:00 – Troponin trends and evidence of ongoing ischemia 02:00 – Recognizing RV failure as the dominant problem 03:00 – Why balloon pump and inotropes failed 04:00 – Decision to unload the RV first 05:00 – Transitioning toward BiPella physiology 06:00 – Hemodynamics that triggered LV unloading 07:00 – PCI strategy under biventricular support 08:00 – Renal recovery and early organ response 09:00 – Weaning strategy and support sequencing 10:00 – BiPella as bridge to recovery vs advanced therapies 11:00 – Final lessons: unload, don’t overstimulate 🔔 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 #BiPella #BiventricularSupport #CardiogenicShock #AcuteMI #MechanicalCirculatorySupport #Impella #CriticalCareCardiology #InterventionalCardiology #MurmurMD

    31 min
  3. How to Build a High-Functioning Valve Clinic: Structure, Workflow, and Real-World Lessons

    29 JAN

    How to Build a High-Functioning Valve Clinic: Structure, Workflow, and Real-World Lessons

    A successful valve program isn’t built in the cath lab alone — it’s built in the clinic, the workflow, and the team structure behind the scenes. In this MurmurMD discussion, Dr. Andrei Pop and Caitlin O'Callaghan Reen, CNP, FACC walk through how they’ve structured and scaled a high-functioning valve clinic, covering everything from referrals and imaging to staffing models and follow-up. The conversation breaks down what actually works in day-to-day practice, including: • Why valve clinics must be process-driven, not physician-dependent • How referral pathways determine procedural volume and case quality • Organizing clinic flow around echo, CT, and multidisciplinary review • The role of APPs, nurses, coordinators, and administrators • Avoiding bottlenecks between clinic, imaging, and procedure scheduling • Managing TAVR, TEER, and surgical referrals in a single ecosystem • Pre-visit planning to reduce wasted clinic visits • Post-procedure follow-up models that prevent patients from being lost • How data tracking and communication improve outcomes and efficiency • Common mistakes programs make when scaling too quickly 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-stor...📺 Follow us on YouTube: / @murmurmd Chapters: 00:00 – Why valve clinic structure matters 01:00 – Referral pathways and patient intake 02:00 – Clinic workflow and visit organization 03:00 – Imaging coordination: echo, CT, and review 04:00 – Multidisciplinary decision-making 05:00 – Staffing models and role definitions 06:00 – APPs and coordinators as the backbone of the clinic 07:00 – Scheduling procedures without bottlenecks 08:00 – Managing multiple valve therapies in one clinic 09:00 – Pre-visit planning to improve efficiency 10:00 – Post-procedure follow-up and continuity of care 11:00 – Tracking outcomes and operational metrics 12:00 – Common pitfalls when scaling a valve program 13:00 – Final lessons for sustainable growth #StructuralHeart #ValveClinic #TAVR #TEER #HeartTeam #HealthcareOperations #Cardiology #ProgramBuilding #MurmurMD

    43 min
  4. Watchman TruSteer deep dive & Cases Steering, Coaxiality, and Deployment Efficiency in LAAC

    14 JAN

    Watchman TruSteer deep dive & Cases Steering, Coaxiality, and Deployment Efficiency in LAAC

    In this MurmurMD discussion, Dr. Raghava Gollapudi and Dr. Arvin Narula break down how the Watchman TruSteer sheath changes left atrial appendage occlusion (LAAO) workflows — from transeptal access to final device deployment. The conversation focuses on real-world use, and highlights when TruSteer adds value, how it improves coaxiality, and why many operators are moving toward using it routinely. Topics covered in this transcript-based discussion include: • Why earlier Watchman sheaths limited depth and stability • How TruSteer allows four-directional control (superior, inferior, anterior, posterior) • Using the device body and sheath as complementary anchoring mechanisms • Improving coaxial alignment without repeating transeptal puncture • Why TruSteer reduces redeployments and manipulation • Large anterior chicken-wing, flat, and posterior appendage anatomy • Efficiency gains vs cost considerations • Why some operators now use TruSteer in nearly every case • Safety pearls: avoiding steering with the dilator in place • Minimizing air and bubble risk by reducing sheath exchanges • Achieving zero-leak goals in the Watchman FLX era A practical discussion for operators looking to improve precision, safety, and efficiency in LAAO. 🔔 Subscribe for more insights from interventional experts and real-world program builders. 📱 Download the app: https://apps.apple.com/app/apple-stor... 📺 Follow us on YouTube: / @murmurmd Chapters: 00:00 – Introduction to Watchman TruSteer 00:40 – Limitations of earlier Watchman sheaths 01:40 – Four-directional steering and coaxial control 03:00 – Using the sheath vs the device body for positioning 04:10 – Challenging appendage anatomy: chicken-wing and posterior LAA 05:30 – Improving depth without repeating transeptal 06:40 – Efficiency, safety, and air management 08:00 – Cost vs value: when TruSteer adds benefit 09:20 – Zero-leak mindset in the FLX era 10:40 – Safety tips and final takeaways #LAAO #LAAC #Watchman #TruSteer #StructuralHeart #InterventionalCardiology #CathLab #MurmurMD #WatchmanFLX #LeftAtrialAppendage

    22 min

  5. 29/12/2025

    Common Femoral Disease Without Surgery? Two High-Risk Cases and Modern Endovascular Strategy with Dr. Sayfo and Dr. Mouawad

    Redo groins, radiation injury, prior infection, and failed bypasses make common femoral artery disease some of the most difficult decisions in vascular care. In this case-based discussion, Dr. Nick Mouawad and Dr. Sameh Sayfo walk through two challenging common femoral artery cases where traditional open surgery carried high risk. Topics covered include: • Managing CFA bifurcation disease after prior radiation and surgical complications • Why the profunda femoris artery must always be protected • Radial-to-peripheral access to avoid hostile groins • Intravascular imaging to guide vessel sizing and therapy • When to use IVL, atherectomy, serration balloons, and DCB • Avoiding stents in the common femoral whenever possible • Multidisciplinary decision-making for durable outcomes A practical, honest discussion focused on patient selection, technique, and long-term durability in modern peripheral 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 setup and goals of discussion 00:45 – Prior pelvic radiation and failed CFA surgery 02:05 – Risks of redo open CFA endarterectomy 03:10 – Why the profunda femoris must be protected 04:20 – Radial access strategy to avoid hostile groins 05:05 – IVUS-guided sizing and IVL preparation 06:00 – Serration balloons and DCB for CFA disease 07:15 – Avoiding stents in the common femoral artery 07:55 – Second case: prior fem-fem bypass and claudication 09:10 – Crossing strategy and imaging uncertainty 10:05 – Orbital atherectomy near bypass anastomosis 11:45 – IVUS, gradients, and confirming success 12:45 – Durability vs redo surgery discussion 14:00 – Multidisciplinary collaboration and MurmurMD #CommonFemoralArtery #PeripheralArteryDisease #IVL #IVUS #Endovascular #VascularSurgery #RedoGroin #RadialToPeripheral #MurmurMD #MultidisciplinaryCare

    16 min
  6. Leaflet Modification: Basilica, Shortcut, and the Future of Coronary Protection with Dr. Toby Rogers and Dr. Andrei Pop

    18/12/2025

    Leaflet Modification: Basilica, Shortcut, and the Future of Coronary Protection with Dr. Toby Rogers and Dr. Andrei Pop

    Leaflet modification has rapidly evolved from niche innovation to a cornerstone of lifetime TAVR management. In this discussion, Dr. Toby Rogers joins Dr. Andrei Pop to explore the latest data, device advances, and clinical decision-making behind Basilica, Shortcut, and emerging techniques like Telltale, Unicorn, and leaflet excision. Key topics covered: History of leaflet modification — from LAMPOON to BASILICA and now device-guided procedures How Shortcut and Telltale are changing training and access Why leaflet modification is still primarily for TAV-in-SAV but expanding to redo-TAVR Balancing risk, complexity, and informed consent for lower-risk patients Role of CT simulation, FEops, and DASI modeling for lifetime valve planning When to err on the side of leaflet modification vs risking coronary obstruction Coronary height and valve-to-coronary distance — why those 2–4mm cutoffs aren’t gospel Future directions: routine modification, improved washout, and potential HALT reduction Access routes (carotid, transcaval, axillary) and practical tips for operators Comparing BASILICA, Shortcut, Unicorn, and Telltale—safety, mechanism, and learning curve Why new devices need structured trials before widespread use This is essential viewing for structural heart operators refining TAVR-in-TAVR safety, coronary access strategies, and the future of leaflet modification. 🔔 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: The evolution of leaflet modification 00:40 – From LAMPoon to BASILICA: history of electrosurgery 02:00 – Off-label origins and why it mattered 03:00 – Shortcut and Telltale: first commercial systems 05:00 – Who qualifies? High-risk vs lower-risk considerations 06:30 – Lifetime management and early valve planning 08:00 – Simulation tools (3Mensio, FEops, DASI) in valve strategy 09:30 – Challenges in coronary height and valve-to-coronary measurement 12:00 – Surgical perspective: root enlargement and small annuli 13:00 – Rethinking the “risk-based” TAVR vs SAVR decision 15:00 – When to err toward leaflet modification 17:00 – New benefits beyond obstruction: access & flow dynamics 19:00 – Routine modification in the future? 20:00 – Cerebral protection data and operator practices 23:00 – Access routes: transfemoral vs transcarotid approaches 25:00 – Comparing BASILICA, Shortcut, Unicorn & Telltale 28:00 – Risks of balloon-tear methods and lack of validation 30:00 – Data-driven advancement vs anecdotal adoption 31:00 – Future of device design and mitral implications 33:00 – Closing remarks and next frontier: mitral leaflet work #LeafletModification #BASILICA #Shortcut #Telltale #TAVRinTAVR #ValveinValve #StructuralHeart #CoronaryProtection #AorticValve #MurmurMD

    34 min
  7. Fixing a Calcified LIMA: Rota, Shockwave, and DCB in a Tortuous Distal LAD with Dr. Arvin Narula and Dr. Joe Walsh

    10/12/2025

    Fixing a Calcified LIMA: Rota, Shockwave, and DCB in a Tortuous Distal LAD with Dr. Arvin Narula and Dr. Joe Walsh

    LIMA interventions are rare, high-risk, and technically unforgiving. In this MurmurMD case session, Dr. Arvin Narula and Dr. Joe Walsh walk through an extremely challenging LIMA-to-LAD lesion involving heavy calcification, tortuosity, failed prior PCI, device entrapment, rotational atherectomy, Shockwave IVL, and management of unexpected graft thrombus. This discussion delivers real-world strategy, troubleshooting, and device thinking you won’t find in textbooks. Key insights from the case: • Why left distal transradial can provide safer LIMA engagement • The moment a Corsair microcatheter is “chewed up” — and why that signals severe calcium • How to decide between more support, downsizing, or plaque modification • When rotational atherectomy is safe in a LIMA graft — and when it’s not • Why starting the burr in the native LAD, not the graft, may reduce risk • How dual preparation (Rota + Shockwave) improves expansion • DCB strategy for distal LAD disease • Managing LIMA thrombus: ACT troubleshooting, lytics, aspiration, and stent “tattooing” • Tricks for keeping thrombus from embolizing distally • How to avoid dissecting the LIMA ostium during exchanges • What to do if ACT remains subtherapeutic despite multiple boluses This is an advanced case with invaluable pearls for anyone treating heavily calcified coronaries, bypass graft disease, or LIMA interventions. 🔔 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 LIMA interventions are challenging 00:40 – Patient background and LIMA access strategy 01:20 – Tortuosity, calcium, and microcatheter difficulty 02:00 – Deciding to escalate to rotational atherectomy 02:40 – Rota technique and safety considerations in LIMA 03:30 – Adding Shockwave for dual preparation 04:10 – DCB strategy for distal LAD disease 04:50 – Managing sudden LIMA thrombus and low ACT 05:40 – Final result and key takeaways #ComplexPCI #LIMAIntervention #RotationalAtherectomy #ShockwaveIVL #DCB #Atherectomy #CoronaryCalcium #InterventionalCardiology #BypassGraftPCI #CathLab #MurmurMD

    17 min
  8. Mastering PASCAL in Complex Mitral Anatomy: Strategy, Technique, and Real-World Lessons: SWAC Nov 25

    04/12/2025

    Mastering PASCAL in Complex Mitral Anatomy: Strategy, Technique, and Real-World Lessons: SWAC Nov 25

    Complex mitral valve anatomy continues to challenge even the most experienced TEER operators. In this month's SWAC conference, Dr. Sergio Garcia, Dr. Tom Waggoner, Dr. Mark Bieniarz, and Dr. Aidan Raney walk through how to approach PASCAL therapy in anatomies where leaflet length, clefts, stenosis, and calcification make decision-making difficult. Using multiple real patient examples, they break down: • How PASCAL’s separatable clasps change strategy in short posterior leaflets • When to choose PASCAL vs Pascal Ace based on anatomy • Managing posterior leaflet restriction, clefts, and deep scallop gaps • How clasping technique differs from MitraClip • Imaging keys for procedural success on transesophageal echo • When to attempt independent clasping—and when not to • Avoiding iatrogenic mitral stenosis • What to do when coaptation depth is low or leaflet mobility is asymmetric • Real-world case outcomes, lessons, and clinical pearls from each scenario A must-watch for operators training in PASCAL or managing anatomies that push TEER beyond standard degenerative or functional mitral regurgitation. Chapters: 00:00 – Introduction: Why complex mitral anatomy requires a different strategy 01:00 – Case review overview and PASCAL system fundamentals 01:40 – Leaflet length, calcium, clefts: deciding if TEER is feasible 02:20 – When to choose PASCAL vs Pascal Ace 03:00 – Understanding PASCAL’s independent clasping advantage 03:40 – Case 1: Short posterior leaflet and how to secure a durable grasp 04:20 – Using TEE to confirm leaflet insertion and avoid chordal entanglement 04:50 – Maneuvering around a cleft and choosing the correct landing zone 05:20 – Case 2: Posterior leaflet restriction and reduced mobility 05:50 – Why independent clasping helps unequal coaptation 06:20 – Residual MR strategies: reposition, reclasp, or add a second device 06:50 – Case 3: When coaptation depth is too shallow for a central grasp 07:20 – Recognizing when stenosis risk outweighs TEER benefit 07:45 – Procedural adjustments when leaflet tissue is limited 08:10 – Case 4: Complex functional MR with tenting and asymmetric jets 08:45 – TEE markers for good versus poor grasping zones 09:10 – Post-grasp evaluation: gradients, residual jets, and stability 09:40 – Final thoughts: how PASCAL expands TEER into anatomies once avoided 🔔 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 #Mitr alValve #TEER #PASCAL #StructuralHeart #TAVR #HeartTeam #EchoGuidedProcedures #InterventionalCardiology #MitralRegurgitation #MurmurMD #SWAC

    1h 18m
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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
    33
  • Rating
    Clean
  • Copyright
    © MurmurMD
  • Show Website
    The Murmur Pod