The Murmur Pod

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 undersell...

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 calc...

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...

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 fil...

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...

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:...

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...

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...

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 Aer...

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" candidat...

Intracardiac masses have traditionally meant high-risk surgery — but transcatheter approaches are changing what’s possible in structural and endovascular intervention. In this MurmurMD discussion, Dr. Abdallah El Sabbagh and Dr. Andrei Pop review the evolving role of transcatheter removal of intracardiac masses, focusing on procedural planning, imaging guidance, device strategy, and patient select...

Building a successful LAAO program requires more than procedural skill — it depends on workflow efficiency, team coordination, and scalable systems. In this MurmurMD discussion, Dr. Vijay Iyer and Dr. Joe Walsh break down the key drivers behind LAAO program efficiency and growth, focusing on how high-performing programs optimize patient flow, referrals, procedural planning, and long-term expansion...

As TAVR expands into younger and lower-risk patients, one question continues to drive decision-making: how durable are transcatheter valves over time? In this MurmurMD discussion, Dr. Robert W. Yeh reviews his late-breaker at CRT26, the Evolut valve durability data, focusing on long-term outcomes and what they mean for real-world clinical practice with Dr. Matthew Summers. Key insights from the tr...

High-risk PCI isn’t just about technique — it’s about protecting the patient while you fix the artery. In this MurmurMD discussion, Dr. Chris Brown and Dr. Yousif Ahmad walk through the role of left ventricular (LV) support in complex PCI, focusing on when to escalate, how to think about hemodynamics, and why support can change the entire strategy. Key insights from the discussion include: • Ident...

The Champion AF trial is one of the most important studies in structural heart — directly comparing left atrial appendage closure (LAAC) to DOAC therapy in patients with atrial fibrillation. In this MurmurMD discussion, Dr. Saibal Kar and Dr. Thomas Waggoner break down the Champion AF data, focusing on what the results actually mean for clinical practice and how they may shift long-term management...

Stent thrombosis is one of the most high-stakes complications in PCI — and getting the mechanism right is everything. In this MurmurMD case discussion, Dr. Nyal Borges and Dr. Joe Walsh walk through a real-world case of stent thrombosis, focusing on how intravascular imaging (IVUS) guides diagnosis and how drug-coated balloons (DCB) fit into the treatment strategy. Key discussion points from the t...

Successful TAVR depends on precise positioning, controlled deployment, and a clear procedural strategy. In this MurmurMD discussion, Dr. Nathan Frogge and Dr. Matthew Summers review key TAVR valve implantation techniques (highlighting Cusp Overlap), focusing on how to optimize positioning, manage deployment, and improve procedural outcomes. Key discussion points from the transcript include: • Plan...

Ostial RCA disease can be one of the most unforgiving lesions in coronary intervention — especially when multiple layers of stent are already present. In this MurmurMD case discussion, Dr. Nyal Borges and Dr. Joe Walsh review a challenging PCI involving two layers of stent at the ostial right coronary artery, focusing on how imaging and careful technique guide treatment decisions. The discussion w...

The cusp overlap technique has become an important strategy during TAVR with self-expanding valves to improve implant depth control and reduce conduction disturbances. In this MurmurMD discussion, Dr. Nathan Frogge and Dr. Matthew Summers walk through how and why they use the cusp overlap technique, focusing on fluoroscopic positioning, implant depth control, and procedural workflow adjustments. K...

As TAVR expands into younger and lower-risk populations, valve durability has become a central question in structural heart care. In this MurmurMD discussion, Dr. Curtiss Stinis and Dr. Andrei Pop review current understanding of TAVR valve durability, focusing on how clinicians interpret available data and apply it to real-world patient decisions. The conversation highlights key themes from the tr...

Complex coronary PCI often requires careful planning, imaging, and stepwise escalation of technique to achieve a safe and durable result. In this MurmurMD case discussion, Dr. Chris Brown and Dr. Eric Rothstein review a challenging coronary intervention and walk through the decision-making process used throughout the procedure. The conversation highlights key aspects of managing difficult coronary...

Structural heart interventions increasingly involve patients with severe ventricular dysfunction, valvular shock, or limited hemodynamic reserve. In these cases, maintaining stability throughout the procedure can be the biggest challenge. In this MurmurMD discussion and case review, Dr. Gennaro Giustino and Dr. Andrei Pop review how LAVA ECMO (Left Atrial Veno-Arterial ECMO) can be used to support...

Cardiogenic shock cases demand rapid recognition, structured thinking, and decisive escalation of support. In this MurmurMD case discussion, operators review a complex patient presentation with cardiogenic shock and walk through the clinical reasoning that guided management decisions. The conversation focuses on practical decision-making during shock physiology, including: • Recognizing early sign...

Iliac CTO interventions follow patterns — but recognizing them in real time is what separates a difficult case from a controlled one. In this MurmurMD case discussion, Dr. Jay Mohan and Dr. Sameh Sayfo walk through two iliac CTO interventions, highlighting practical lessons in access strategy, crossing techniques, IVUS guidance, and covered stent deployment. Key concepts discussed directly from th...

As TAVR expands into younger and lower-risk populations, TAVR explant is no longer a theoretical problem — it’s a real and growing clinical scenario. In this MurmurMD discussion, Dr. Clinton Kemp and Dr. Matt Summers walk through the indications, technical challenges, and operative considerations involved in TAVR explant, emphasizing why early planning and multidisciplinary alignment are critical...