The Murmur Pod

Coronary IVL has changed how many operators treat calcified coronary disease, but the technology is still evolving.

In this MurmurMD discussion, Dr. Nyal Borges speaks with Dr. Matthew Price from Scripps about SEISMIQ, Boston Scientific’s investigational IVL catheter, and where it may fit in the coronary calcium-modification toolkit.

The discussion breaks down how SEISMIQ differs from current IVL platforms. Instead of using ele...

Mechanical circulatory support in cardiac surgery is not just a bailout strategy- it can be a way to prevent the shock cascade before it becomes difficult to reverse.

In this MurmurMD discussion, Dr. Chris Brown speaks with Dr. Robert Farivar about how he uses mechanical support before, during, and after cardiac surgery.

Dr. Farivar explains why the EACTS-STS guidance reinforces a practice pattern he has followed for years: identify ...

Below-the-knee disease remains one of the most difficult areas in vascular intervention: small vessels, severe calcification, acute recoil, aggressive restenosis, and patients who often present with CLTI, diabetes, CKD, wounds, and limited surgical options.

In this MurmurMD discussion, Dr. Sameh Sayfo speaks with Dr. S Jay Mathews about the evolution of below-the-knee disease treatment — from plain balloon angioplasty to IVUS-...

As TAVR moves into younger patients, the first implant is no longer just about getting a good result today, it may determine every future option.

In this MurmurMD discussion, Dr. Nathan Frogge and Dr. Andrei Pop review the concept of optimizing the index TAVR implant, using the CODE framework: coaxiality, orientation, depth, and expansion.

The conversation is a candid look at where TAVR technique is headed, and where the evidence sti...

This MurmurMD case discussion features Dr. Chris Brown and Dr. Christian McNeely walking through a high-risk PCI case where the hardest part was not just the calcium, it was deciding when and how to intervene safely.

The patient was an 82-year-old frail female who presented with chest pain and NSTEMI. Angiography showed heavily calcified distal left main disease, proximal circumflex disease, a tight calcified mid-LAD, moderate LV dy...

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...

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 ...

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...

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 ...

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 cli...

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 throu...

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 stenos...

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 occlude...

Below-the-knee CLTI is rarely straightforward especially in patients with diabetes, dialysis, medial arterial calcification, toe wounds, gangrene, and misleading ABIs.

In this MurmurMD discussion, Dr. Sameh Sayfo is joined by Dr. Michael Siah, vascular surgeon at UT Southwestern, to review real-world vascular cases using intravascular lithotripsy, including Javelin and E8 strategies for tibial and pedal disease.

The conversation focu...

Coronary IVL has changed the way operators approach calcified coronary disease, but the mechanism is often underappreciated because the device is so simple to use.

In this MurmurMD discussion, Dr. Chris Brown and Dr. Yousif Ahmad walks through a complex calcified coronary case and then breaks down the mechanism of action behind coronary intravascular lithotripsy.

The conversation focuses on Aero: improved deliverability, rewrap, and ...

In this MurmurMD discussion, Dr. Chetan Huded reviews the major trial data shaping modern LAA closure decision-making, including PROTECT AF, PREVAIL, PRAGUE-17, CLOSURE-AF, OPTION, and CHAMPION AF.

The conversation focuses on the real clinical question facing physicians today:

Can LAA closure match DOAC therapy for stroke prevention while reducing long-term bleeding risk?

Key topics include:

• LAA closure vs DOACs for stroke prevention

...

Drug-coated balloons are creating new options in complex coronary intervention, but only when the lesion is prepared correctly.

In this MurmurMD discussion, Dr. Nyal Borges and Dr. Pratik Sandesara walk through a practical, case-based approach to contemporary DCB use, focusing on ISR, calcific neoatherosclerosis, underexpanded stents, and bifurcation disease.

The conversation starts with a severe LAD ISR case involving jailed diagona...

For years, the biggest limitation of coronary IVL wasn’t its ability to modify calcium- it was deliverability.

In this MurmurMD discussion, Dr. Yousif Ahmad and Dr. Chris Brown review early real-world experience with Aero, ⁨@ShockwaveMedical⁩ IVL platform designed to improve crossability, flexibility, rewrap, and treatment efficiency in calcified coronary anatomy.

The discussion focuses on how Aero changes day-to-day decision-m...

What happens when a patient has critical limb-threatening ischemia, severe calcification, no distal targets, and has failed traditional endovascular therapy?

In this MurmurMD discussion, Dr. Andres Vargas Estrada and Dr. Sameh Sayfo explain the evolution of Deep Vein Arterialization (DVA/TADV) and why it has become a powerful option for patients previously considered "no-option" candidates.

The conversation explores the changing land...