Saturday 27 September 2014
TRANSCATHETAR AORTIC VALVE IMPLANT
Design of Sapien XT valve and technical tips - By Dr Shahid Merchant
Introduction : Transfemoral aortic valve implantation (TAVI) may offer clinical benefit to patients not well suited to conventional surgery. New developments in delivery systems and valve technologies make the procedure safer, thereby paving the way for a broader application of Transfemoral aortic valve implantation.
Patients with severe symptomatic aortic stenosis are eligible for transarterial aortic valve replacement if the risk of conventional open-heart aortic valve replacement is considered excessive by a consensus group of cardiogists and heart surgeons. A minimal femoral arterial diameter of 7 mm for the 22 F and 8 mm for the 24 F Retroflex 3 system and 6 mm for the 18 F and 6.5 mm for the 19 F Nova flex system is required.
Introduction : Transfemoral aortic valve implantation (TAVI) may offer clinical benefit to patients not well suited to conventional surgery. New developments in delivery systems and valve technologies make the procedure safer, thereby paving the way for a broader application of Transfemoral aortic valve implantation.
Patients with severe symptomatic aortic stenosis are eligible for transarterial aortic valve replacement if the risk of conventional open-heart aortic valve replacement is considered excessive by a consensus group of cardiogists and heart surgeons. A minimal femoral arterial diameter of 7 mm for the 22 F and 8 mm for the 24 F Retroflex 3 system and 6 mm for the 18 F and 6.5 mm for the 19 F Nova flex system is required.
Procedure : is done under local anaesthesia and mild sedation. A percutaneous femoral arterial sheath allows introduction of the delivery system into the descending aorta. Flexion of the delivery catheter tip facilities atraumatic passage through the aortic arch and stenotic native valve. The delivery catheter is withdrawn to the ascending aorta to fully expose the deployment balloon during expansion. The valve is deployed during rapid pacing. Finally the delivery system is retrieved and femoral access site closed either utilizing previously inserted percutaneous sutures (ProGlide TM Prostar ) or by surgical cutdown.
Sapien XT valve : The valve consists of bovine pericardial leaflets, a cobalt-chromium frame and a sealing cuff on the inflow aspect of the stent to prevent paravalvular regurgitation. The bovine pericardium utilized undergoes a proprietary anti-calcification treatment (Thermafix Tm ).
New scallop-shaped leaflets are attached to the frame in a crown-like manner. The redesigned frame incorporates a more open design and a reduction in strut thickness. Stainless steel utilized in the SAPIEN valve is now replaced with a stronger cobalt-chromium alloy.
The design and the material allow for tighter crimping of the valve, without loss of stability or radial force. The SAPIEN XT aortic valve is available in four sizes: 20, 23, 26, and 29 mm external diameter valves. It is slightly longer that the previous SAPIEN valve.
New scallop-shaped leaflets are attached to the frame in a crown-like manner. The redesigned frame incorporates a more open design and a reduction in strut thickness. Stainless steel utilized in the SAPIEN valve is now replaced with a stronger cobalt-chromium alloy.
The design and the material allow for tighter crimping of the valve, without loss of stability or radial force. The SAPIEN XT aortic valve is available in four sizes: 20, 23, 26, and 29 mm external diameter valves. It is slightly longer that the previous SAPIEN valve.
Novaflex delivery system : The system allows for a reduction in sheath size to 18 French (for the 23 mm valve; 19 French for the 26 mm valve). The smaller diameter allows use in patients with smaller diameter ilofemoral arteries: 6 mm for the 18 French and 6.5 mm arterial diameter for the 19 French systems.
The delivery catheter incorporates an outer deflectable catheter and an inner balloon catheter with a tapered crossing tip. The valve itself is crimped on the inner catheter proximal to the inflatable balloon. This reduces the maximal diameter of the delivery catheter and allows for a reduction in sheath size. Once the delivery catheter and prosthesis have been passed through the femoral sheath, the inner balloon catheter is withdrawn back into the outer catheter while maintaining wire position. The outer catheter then advances the prosthesis distally on the inner catheter shaft and onto the balloon. Optimal alignment of the stent on the balloon is indicated when the frame is positioned between the two fluoroscopic markers. Imaging in a fluoroscopic view perpendicular to the markers is important for accurate positioning. Advancing the prosthesis too distally is prevented by a slightly larger distal tip of the balloon catheter. Fine adjustment is achieved by turning a valve alignment wheel situated on the handle of the delivery system.
Balloon expansion generally begins distal (ventricular) to the prosthesis first, followed by expansion proximal (aortic) to the prosthesis and finally by expansion of the central portion of the balloon. The result is initial expansion of the prosthesis within the left ventricular outflow tract (LVOT).
The delivery catheter incorporates an outer deflectable catheter and an inner balloon catheter with a tapered crossing tip. The valve itself is crimped on the inner catheter proximal to the inflatable balloon. This reduces the maximal diameter of the delivery catheter and allows for a reduction in sheath size. Once the delivery catheter and prosthesis have been passed through the femoral sheath, the inner balloon catheter is withdrawn back into the outer catheter while maintaining wire position. The outer catheter then advances the prosthesis distally on the inner catheter shaft and onto the balloon. Optimal alignment of the stent on the balloon is indicated when the frame is positioned between the two fluoroscopic markers. Imaging in a fluoroscopic view perpendicular to the markers is important for accurate positioning. Advancing the prosthesis too distally is prevented by a slightly larger distal tip of the balloon catheter. Fine adjustment is achieved by turning a valve alignment wheel situated on the handle of the delivery system.
Balloon expansion generally begins distal (ventricular) to the prosthesis first, followed by expansion proximal (aortic) to the prosthesis and finally by expansion of the central portion of the balloon. The result is initial expansion of the prosthesis within the left ventricular outflow tract (LVOT).
SAPIEN XT valve on the Novaflex delivery system : This allows a further reduction in internal sheath diameter to 18 French and 19 French, respectively. The absence of major vascular complications and major bleeds is encouraging.
The new design tends to result in balloon expansion being initiated distally (ventricular). As the prosthesis expands distally, it first contacts the outflow tract, rather that the leaflets. Subsequently, proximal (aortic) expansion is less likely to result in movement in the direction of blood flow and the native leaflets. Presumably more rapid balloon inflation due to the larger inflation lumen helps.
The new design tends to result in balloon expansion being initiated distally (ventricular). As the prosthesis expands distally, it first contacts the outflow tract, rather that the leaflets. Subsequently, proximal (aortic) expansion is less likely to result in movement in the direction of blood flow and the native leaflets. Presumably more rapid balloon inflation due to the larger inflation lumen helps.
Friday 19 September 2014
Cardiac Updates
MY APPROACH TO TREATMENT OF HEART ATTACK 2010
We all fear the word heart attack for it is one of the leading killers of both men and women all around the world. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent diabities & death. At the onset of a heart attack, what is most important is the first 1 hour that is termed "the golden hour" by doctors.
Traditionally, when a person suffers from a heart attack, the doctors perform an angioplasty to surgically open up the blockages and restore normal blood flow. But in a city like Mumbai, a typical scene would involve the family calling up an ambulance and taking the patient to a renowned hospital that may be very far from the house, So by the time the patient, reaches the hospital and the surgeons prepare themselves for surgery that golden period of treatment is already gone leaving behind a heart that is damaged as much as 80% which not only decreases the rate of survival but also seriousily affects the 1 year mortality rate of the patient.
But today there is a life savior in the form of clot busters that are medicines that can be administered within that 1 hour period in a local hospital or in the ambulance while going to a good hospital. It works by dissolving the clot in the coronary artery thus preventing much damage to the heart thereby buyinh some for the angioplasty to be performed in the hospital/ This treatment is called thrombolysis and the benefir recorded is closed to 80%.
Research has come up with some starting statistics:
- 68% of people who suffer from heart attacks have blockages less than 50%
- Mortality rates have come down to 6.5% from 30% after thrombolytic therapy
- Angioplasty stent within 6 hour of lytic thrombolysis is the new Pharmaco Invasive Approach 1 year mortality has come down to 3.2% from 15% with this approach.
A heart attack occurs as a result of a condition called coronary artery disease (CAD) where the blood flow to a certain section of the heart muscle gets blocked. Death occurs because of damage caused to the section of heart muscle due to lack of oxygen. Hence it is critical to be treated within the golden hour to save as much of the heart tissue is possible in rder to not only save the patient's life but also extend his lifespan after the attack.
TRANSCATHETAR AORTIC VALVE IMPLANT
Design of Sapien XT valve and technical tips - By Dr Shahid Merchant
Introduction : Transfemoral aortic valve implantation (TAVI) may offer clinical benefit to patients not well suited to conventional surgery. New developments in delivery systems and valve technologies make the procedure safer, thereby paving the way for a broader application of Transfemoral aortic valve implantation.
Patients with severe symptomatic aortic stenosis are eligible for transarterial aortic valve replacement if the risk of conventional open-heart aortic valve replacement is considered excessive by a consensus group of cardiogists and heart surgeons. A minimal femoral arterial diameter of 7 mm for the 22 F and 8 mm for the 24 F Retroflex 3 system and 6 mm for the 18 F and 6.5 mm for the 19 F Nova flex system is required.
Introduction : Transfemoral aortic valve implantation (TAVI) may offer clinical benefit to patients not well suited to conventional surgery. New developments in delivery systems and valve technologies make the procedure safer, thereby paving the way for a broader application of Transfemoral aortic valve implantation.
Patients with severe symptomatic aortic stenosis are eligible for transarterial aortic valve replacement if the risk of conventional open-heart aortic valve replacement is considered excessive by a consensus group of cardiogists and heart surgeons. A minimal femoral arterial diameter of 7 mm for the 22 F and 8 mm for the 24 F Retroflex 3 system and 6 mm for the 18 F and 6.5 mm for the 19 F Nova flex system is required.
Procedure : is done under local anaesthesia and mild sedation. A percutaneous femoral arterial sheath allows introduction of the delivery system into the descending aorta. Flexion of the delivery catheter tip facilities atraumatic passage through the aortic arch and stenotic native valve. The delivery catheter is withdrawn to the ascending aorta to fully expose the deployment balloon during expansion. The valve is deployed during rapid pacing. Finally the delivery system is retrieved and femoral access site closed either utilizing previously inserted percutaneous sutures (ProGlide TM Prostar ) or by surgical cutdown.
Sapien XT valve : The valve consists of bovine pericardial leaflets, a cobalt-chromium frame and a sealing cuff on the inflow aspect of the stent to prevent paravalvular regurgitation. The bovine pericardium utilized undergoes a proprietary anti-calcification treatment (Thermafix Tm ).
New scallop-shaped leaflets are attached to the frame in a crown-like manner. The redesigned frame incorporates a more open design and a reduction in strut thickness. Stainless steel utilized in the SAPIEN valve is now replaced with a stronger cobalt-chromium alloy.
The design and the material allow for tighter crimping of the valve, without loss of stability or radial force. The SAPIEN XT aortic valve is available in four sizes: 20, 23, 26, and 29 mm external diameter valves. It is slightly longer that the previous SAPIEN valve.
New scallop-shaped leaflets are attached to the frame in a crown-like manner. The redesigned frame incorporates a more open design and a reduction in strut thickness. Stainless steel utilized in the SAPIEN valve is now replaced with a stronger cobalt-chromium alloy.
The design and the material allow for tighter crimping of the valve, without loss of stability or radial force. The SAPIEN XT aortic valve is available in four sizes: 20, 23, 26, and 29 mm external diameter valves. It is slightly longer that the previous SAPIEN valve.
Novaflex delivery system : The system allows for a reduction in sheath size to 18 French (for the 23 mm valve; 19 French for the 26 mm valve). The smaller diameter allows use in patients with smaller diameter ilofemoral arteries: 6 mm for the 18 French and 6.5 mm arterial diameter for the 19 French systems.
The delivery catheter incorporates an outer deflectable catheter and an inner balloon catheter with a tapered crossing tip. The valve itself is crimped on the inner catheter proximal to the inflatable balloon. This reduces the maximal diameter of the delivery catheter and allows for a reduction in sheath size. Once the delivery catheter and prosthesis have been passed through the femoral sheath, the inner balloon catheter is withdrawn back into the outer catheter while maintaining wire position. The outer catheter then advances the prosthesis distally on the inner catheter shaft and onto the balloon. Optimal alignment of the stent on the balloon is indicated when the frame is positioned between the two fluoroscopic markers. Imaging in a fluoroscopic view perpendicular to the markers is important for accurate positioning. Advancing the prosthesis too distally is prevented by a slightly larger distal tip of the balloon catheter. Fine adjustment is achieved by turning a valve alignment wheel situated on the handle of the delivery system.
Balloon expansion generally begins distal (ventricular) to the prosthesis first, followed by expansion proximal (aortic) to the prosthesis and finally by expansion of the central portion of the balloon. The result is initial expansion of the prosthesis within the left ventricular outflow tract (LVOT).
The delivery catheter incorporates an outer deflectable catheter and an inner balloon catheter with a tapered crossing tip. The valve itself is crimped on the inner catheter proximal to the inflatable balloon. This reduces the maximal diameter of the delivery catheter and allows for a reduction in sheath size. Once the delivery catheter and prosthesis have been passed through the femoral sheath, the inner balloon catheter is withdrawn back into the outer catheter while maintaining wire position. The outer catheter then advances the prosthesis distally on the inner catheter shaft and onto the balloon. Optimal alignment of the stent on the balloon is indicated when the frame is positioned between the two fluoroscopic markers. Imaging in a fluoroscopic view perpendicular to the markers is important for accurate positioning. Advancing the prosthesis too distally is prevented by a slightly larger distal tip of the balloon catheter. Fine adjustment is achieved by turning a valve alignment wheel situated on the handle of the delivery system.
Balloon expansion generally begins distal (ventricular) to the prosthesis first, followed by expansion proximal (aortic) to the prosthesis and finally by expansion of the central portion of the balloon. The result is initial expansion of the prosthesis within the left ventricular outflow tract (LVOT).
SAPIEN XT valve on the Novaflex delivery system : This allows a further reduction in internal sheath diameter to 18 French and 19 French, respectively. The absence of major vascular complications and major bleeds is encouraging.
The new design tends to result in balloon expansion being initiated distally (ventricular). As the prosthesis expands distally, it first contacts the outflow tract, rather that the leaflets. Subsequently, proximal (aortic) expansion is less likely to result in movement in the direction of blood flow and the native leaflets. Presumably more rapid balloon inflation due to the larger inflation lumen helps.
The new design tends to result in balloon expansion being initiated distally (ventricular). As the prosthesis expands distally, it first contacts the outflow tract, rather that the leaflets. Subsequently, proximal (aortic) expansion is less likely to result in movement in the direction of blood flow and the native leaflets. Presumably more rapid balloon inflation due to the larger inflation lumen helps.
FAQ's
FAQ's
CONTENTS
- What is coronary artery disease?
- What are the effects of coronary artery disease?
- What is Angiography?
- When will your doctor recommend Angiography?
- What are the procedures to relieve coronary artery disease?
- How will your doctor know that you require Angioplasty or surgery?
- What is Percutaneous Transluminal Coronary Angioplasty (PTCA)?
- How is PTCA different from bypass surgery?
- What are the types of Angioplastics and how does your doctor recommend which one is best for you?
- Can one reduce the progress of atherosclerosis and CAD?
WHAT IS CORONARY ARTERY DISEASE?
- Coronary artery disease (CAD) affects the coronary arteries that supply blood to the heart muscle (Fig.1)
- The most common cause of CAD is artheroselerosis, commonly called hardening of arteries.
- Risk Factors : Diabetes, Hypertension, Smoking, High Cholesterol, Ageing, etc.
- Fats, cholesterol and other elements carried in the blood get accumulated in the inner wall of the arteries to form a plaque.
WHAT ARE THE EFFECTS OF CORONARY ARTERY DISEASE?
What is Angina?
Narrowed coronary arteries restrict the amount of blood, that can reach the heart muscle. Fatigue, tightness in the chest or a peculiar crushing type chest pain called angina, may accompany the decreased blood flow.
What is Heart Attack?
If a coronary artery suddenly closes, blood flow to a part of the heart may stop completely. In these cases, some of the heart muscle may be permanently damaged. This is often accompanied by severe chest pain that won't go away. This is called a myocardial infarction or a heart attack (Fig 2).
Test to Detect CAD : -
- Echo / Color DopplerStress Test
- Stress EchoThalliumStress test
- Coronary CT AngioCoronary Angiography
WHAT IS ANGIOGRAPHY?
This procedure is done to see where and to what extent the coronary arteries are blocked. A fine tube is passed along artery in the right thigh or forearm upto the heart (Fig. 4).
A dye is injected and a serial X-ray films are taken to study the flow of dye in the coronary arteries. The pictures will let your doctor see any narrowed or blocked arteries.
Your doctor will inject x-ray dye through the catheters. You may need to take a deep breath when the picture is taken.
When the angioram procedure is over, you will go to a recovery area. The introducer shealth will be taken out before you to go your hospital room or go home.
WHEN WILL YOUR DOCTOR RECOMMEND ANGIOGRAPHY?
Your doctor will recommend angiography under the following circumstances :
- When you have chest pain called Angina on walking or at rest.
- When ECG or Stress test shows chances suggestive of ischemia.
- After a heart attack.
- During a heart attack, in unstable patients with a view to coronary intervention.
- Sometimes, you may have no symptoms called 'silent ischemia' which may be detected or rest or by Stress test. This is no prevent silent heart attack or sudden collapse.
WHAT ARE THE PROCEDURES TO RELIEVE CORONARY ARTERY DISEASE?
When the disease is localized in one or tow arteries, the blockage can be opened by stretching or dilating. This is done by using a small balloon on a tube inside the artery, this procedure is called percutaneous transluminal coronary angioplasty.
HOW WILL THE DOCTOR KNOW THAT YOU REQUIRE SURGERY?
When the blockage is more complicated and involves more coronary arteries, coronary artery by pass surgery is recommended.
WHAT IS PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY?
PTCA is non surgical procedure designed to dilate narrowed coronary arteries. PTCA is similar to your coronary angiogram procedure. IT is performed in the cath lab. In a PTCA, a small catheter with a small balloon attached is passed into the artery, From here, it is passed into the coronary artery (fig.6). The balloon is passed through the blockage. The balloon is inflated to expand the opening in the artery. More blood can flow through the artery, when the balloon is removed.
Your doctor may recommend placing a coronary stent. The coronary stent is designed to help keep the treated area in the artery open and prevent recurrence.
If you need a stent, you may need to take special medications like Aspirin and Clopidogrel before it is placed.
HOW IS PTCA DIFFERENT FROM BYPASS SURGERY?
Both operations achieve the same result. They increase the blood flow to the heart muscle.
In the PTCA the obstructed part of the coronary artery is widened with a balloon catheter and a stent is placed.
It is non surgical, no incision is made and can be done during angiography.
In coronary artery bypass surgery a detour around the narrowed or blocked part of the coronary artery is constructed using a length of vien or artery taken from inside the chest. It is a major surgery involving opening of the chest. It is a major surgery involving opening of the chest, putting the heart on the heart - lung machine, using octopus in beating heart surgery, a prolonged hospital stay and a greater risk and morbidity.
WHAT ARE THE TYPES OF ANGIOPLASTIES AND HOW DOES YOUR DOCTOR RECOMMEND WHICH ONE IS BEST FOR YOU?
The types of Angioplastics :
- Balloon
- Bare Metal Stents
- Medicated Stents
- Lasers
- Rotablators
WHAT ARE STENTS? WHY IS STENT SO IMPORTANT FOR YOUR TREATMENT?
A coronary stent remains in your body. It is shaped like a small round tube. A stent is usually made of medical - grade stainless steel. The coronary stent is designed to support the wall of the coronary artery.
The stent is placed on a balloon catheter like the one used for a PTCA. The stent and the balloon catheter are passed through the blockage. The balloon is tehn inflated. This causes the stent to extend inside the artery.
After the stent has been expanded, the balloon is deflated and removed. The stent stays inside the artery to help keep the artery open. This improves the blood flow to the heart and helps relieve chest pain.
AFTER YOUR STENT PROCEDURE
Your stay in the hospital can be from one to three days. For the first eight to twenty-four hours after your procedure, it is very importance not to bend your 'procedure leg'. You should also remain flat in bed. The nursing staff will check your leg for warmth and color. They will also look for any bleeding. After the introducer sheath is removed, you will be allowed out of bed.
You will also take a daily dose of Aspirin and clopidogrel as well as a combination of drugs. Some of these medications also help to thin the blood and prevent blood clots.
It is very important that you take all of your medications until your doctor tells you to stop.
GOING HOME FROM THE HOSPITAL
You will be given instructions by your doctor about your physical activites, you will receive information on how to reduce the risks of further coronary atherosclerosis.
The need for PTCA may be reduced or avoided by :
- Changing eating habits and reducing fats and cholesterol in your diet.
- Participating in a regular physician - approved exercise program.
- Reducing or stopping smoking.
- Taking the medicines Aspirin and Clopidogrel regularly as prescribed by your doctor.
After several months, your doctor may want you to have a stress test, This procedure monitors the result of your PTCA and stent placement.
WILL I NEED TO HAVE ANOTHER PTCA?
There are chances. The dilated part of the coronary artery may be narrowed in some patients, within the first six months. After the first six months. After the first six months, if there is no recurrence, then it is not a problem.
What are Medicated Stents (Drug Eluting Stents)?
Stents medicated with drugs like Sirolimus, Paclitaxel, etc on a polymer have virtually eliminated the chance of recurrence. It is very important that you take Aspirin and Clopidogrel along with your other medications under supervision of your doctor. Never stop it without consulting your physician.
LIFE AFTER PTCA
PTCA is performed to restore a person to an active and full life. The goals of the procedure are to enable a person to improve the quality of his life and prevent heart attack. It makes sense to reduce the risk factors by controlling high blood pressure, high blood sugar, maintaining a low fat diet, keeping weight down, to give up smoking and having a sensible exercise and diet program.
WHAT ARE THE NEWER INTERVENTIONS PERFORMED IN THE CATH LAB?
- Angioplasty in acute Heart Attack.
- Angioplasty in acute coronary syndrome (Unstable Angina/non-Q wave MI) Multivessel stenting in triple vessel CAD.
- Drug Eluting Stents with various drugs like rapamycin, paclitaxel, etc. have virtually eliminated the chance of recurrence.
- Rotablation, cutting balloon, coated stents, brachytherapy, intravascular ultrasound, excizer, use of Reopro/Integrilin, IABP, percussage protection device, drug eluting stents etc.
- Angioplasty in post bypass patients with occulded grafts (venous & arterial)
- Carotid artery stenting in stoke/TIA patients.
- Renal artery stenting in renovascular hypertension / renal failure.
- Aorto-iliac, femoral, popliteal, peroneal, subclavian angioplasty and stenting in peripheral vascular disease.
- Septal ablation in hypertrophic obstructive cardiomyopathy.
- Biventricular pacing (cardiac resynchronization device) in dilated cardiomyopathy.
- Aortic, pulmonary, tricuspid and mitral valvuloplasty.
- IVC filter and local thrombolytic therapy in pulmo thrombo - embolism with deep vein thrombosis.
- Umbrella closure device in ASD, PDA shunts.
- Permanent pacemaker implantation VDD, dual chamber pacemaker.
- Electrophysiologic studies with radio frequency ablation in tachyarrythmias and AICD devices.
CAN ONE REDUCE THE PROGRESSION OF ATHEROSCLEROSIS CHANGE IN LIFESTYLE TO REGRESS CORONOARY ARTERY DISEASE
- Low fat vegetarian diet consist of : -
70-75% complex carbohydrates (starches - grains, beans, vegetables, fruits)
10% Fats (yogurt or non-fat milk, cooking oil)
15-20% Protein (beans, egg white) - Aerobic Exercise
Moderate paced walks 30 mins a day or 1 hour every alternate day - Stress Management Techniques
- Stretching Exercises (Yogic Asanas)
- Deep breathing (Pranayama)
- Meditation
- Quit Smoking
- Sr Cholestrol < 150, LDL < 80, HDL > 45, TG < 100 mg/dl
- Maintain body weight to ideal body weight.
- Control of Risk Factors : diabetes, hypertension etc.
- Regular medicines as prescribed.
- Aspirin and Clopidogrel (blood thinners)
- Statins (cholesterol lowering drugs)
- Nitrates (arterial vasodilator)
- Beta Blockers, ACE-Inhibitors, Angiotensin Receptor Blocker, Calcium Channel Blockers
- Newer anti-anginal drugs : Nicorandil, Ivabradine, Ranolazine
- Regular Cardiac Fitness Evaluation : Clinical & risk factors assessment, ECG, 2-D Echo, Stress test, Stress Thallium, CT Angio, Sr lipid profile.
Friday 12 September 2014
Testimonials
Testimonials
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by Dr. Ismail Shailkh, Senior GP, Jogeshwari, Mumbai
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by Mrs. Mahfooda, housewife, Oman
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by Tirlok Singh Rai, Chairman, Raiply Group,
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by Victor Dharmai, Ex. Employee, Siemens
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by Zorabian, Chairman, Zorabian Poultry, Karjat
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by Dr Bedi, Industrialist
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by Mr. M. A. Khan, businessman
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by Mrs. Fatima Jasadanwala, housewife
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by Mumtaz Sayed, Housewife
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by Nassim D'souza, Manager, Emirates Airlines
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by Khalid Khan, Employee ONGC
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Soluble Scaffold for Complex Heart Disease
Soluble Scaffold
for Complex Heart Disease
The latest in stent technology to treat blockages and
heart arteries the scaffold dissolves in 12 month and replaced by normal structural
and functional arterial wall and increase in 18% luminal size of heart artery.
Dr. Merchant is credited to be the first Cardiologist in
Mumbai to implant the 1st soluble scaffold and involved in treating
complex carnery disease with multiple soluble stents successfully. Dr. Merchant
is credited to be the 1st interventional cardiologist in India and
perhaps in the world to implant soluble stent in 25 years old patient with
massive heart attack and soluble stent in an 83 year old bed-ridden lady in below
knee artery in a diabetic foot.
Know more here http://www.drmerchant.in/
Saturday 6 September 2014
Tips & Tricks
1) Multiple Approaches
- Kissing stents as the first plan
- Wire both vessels LAD and circumflex and stent Ostium of LAD without struts of stents protruding into left main. Be exactly at the LAD Ostium to be seen in LAO caudial & RAO caudial view
- Keep a balloon inflated in circumflex and inflate at 2 to 3 ATM when deploy in stent at Ostium of LAD artery to prevent plaque shift.
2) Use of prophylactic IABP for
Patients with Low EF
Graft PTCA with Low EF
Only remaining vessel angioplasty
Multi vessel stenting with Low EF
Patients with Low EF
Graft PTCA with Low EF
Only remaining vessel angioplasty
Multi vessel stenting with Low EF
3) Six French (FR) JL 3.5 guide gets sucked in the proximal LAD when removing balloon after deploying. EBU 3 guide is most steady and does not get sucked in the coronary.
4) Calcified lesion
- Mostly adventitial calcium so lesions are easily dilated with balloon
- Calcified lesions do not easily dissect with balloon dilation because they are hard and chronic.
- You can try NC balloon, angiosculpt, rotablator.
Friday 5 September 2014
Professional qualifications & fellowship
Professional qualifications & fellowship :
- 1983 MBBS from Seth G S Medical College, Mumbai University
- 1987 M.D. Int. Medicine, Seth G S Medical College, Mumbai Univesity
- 1990 Diplomat National Boards of Cardiology, New Delhi
- 1991 DM Cardiology, Seth G S Medical College, Mumbai University
- 1992 Fellowship in Interventional Cardiology, University of Rouen, France
- 1993 Fellowship in Interventional Cardiology, Harvard Medical School, USA
| DATE OF BIRTH | : | March 10, 1959 |
| PLACE OF BIRTH | : | Mumbai, India. |
| EDUCATION | ||
| 1987 | : | M. D. in Medicine, Bombay University, India. |
| 1990 | : | D.M. in Cardiology, Bombay University, India. |
| 1989 | : | D. N. B. in Cardiology, National Board Examination, New Delhi, India. |
| 1982 | : | M. B. B. S. Bombay University, India. |
| POSTDOCTORAL TRAINING | ||
| 1982 - 1983 | : | Intern in Medicine & Surgery, King Edward VII Memorial Hospital, Bombay, India. |
| 1983 - 1987 | : | Resident in Internal Medicine & Subspecialities, King Edward VII Memorial Hospital, Bombay, India. |
| 1987 - 1990 | : | Resident in Cardiology, King Edward VII Memorial Hospital, Bombay, India. |
| 1990 - 1991 | : | Lecturer in Cardiology, King Edward VII Memorial Hospital, India. |
| 1990 | : | Clinical fellow in Interventional Cardiology, Ospadale Multizonale, Varese, Italy. |
| 1991 | : | Clinical fellow in Interventional Cardiology, Hospital Charles Nicolle, University of Rouen, France. |
| 1991 | : | Visiting fellow in Interventional Cardiology Mass General Hospital, Boston, USA. |
| LICENSE AND CERTIFICATION | ||
| 1983 | : | Indian License of Physician & Surgeon. |
| 1987 | : | Doctor of Medicine, Bombay University. |
| 1989 | : | Diplomate of National Board in Cardiology India. |
| 1990 | : | Doctor of Cardiology, Bombay University. |
| 1991 | : | Certification as Interventional Cardiologist, Univeristy of Rouen, France. |
| UNIVERSITY APPONTMENTS | ||
| 1985 - 1987 | : | Registrar in Medicine, Bombay University, India. |
| 1987 - 1990 | : | Registrar in Cardiology, Bombay University, India. |
| 1990 - 1991 | : | Lecturer in Cardiology, Bombay University, India |
| 1991 | : | Fellow in Invasive Cardiology, University of Rouen, France. |
| HOSPITAL APPOINTMENTS | ||
| 1983 - 1985 | : | House officer in Medicine, K. E. M., Hospital Bombay. |
| 1985 - 1987 | : | Registrar in Internal Medicine, K. E. M. Hospital, Bombay. |
| 1987 - 1990 | : | Registrar in Cardiology, K. E. M. Hospital Bombay. |
| 1990 - 1991 | : | Lecturer in Cardiology (Staff position) K. E. M. Hospital, Bombay. |
| 1991 | : | Clinical fellow in Interventional Cardiology, Hospital Charles Nicolle, Rouen, France. |
| 1991 | : | Visiting fellow in Interventional Cardiology, Massachusetts General Hospital & Havard Medical School, Boston. |
| MEMBERSHIP IN PROFESSIONAL SOCIETIES | ||
| 1989 | : | Member of Cardiological Society of India. |
| 1990 | : | Member of French working group on Interventional Cardiology. |
| 1991 | : | Fellow of the European Society of Cardiology. |
| 1991 | : | Co-Director with Prof. A. Criber (France) at a live Demonstration angioplasty & valvuloplasty workshop at Hinduja Hospital, Bombay, co-sponsored by M. G. H., Boston. |
| 1991 | : | International co-ordinator of Cardiological Society of India conference in Hyderabad, India. |
| TEACHING EXPERIENCE | ||
| 1985 - 1990 | : | Clinical teaching to under graduate students in Medicine and Cardiology, Bombay University. |
| 1990 - 1991 | : | Lectures to Post graduate students in Cardiology. |
| MAJOR RESEARCH INTEREST | ||
| 1. Long term results of medicated stents for diffusely diseased small vessels in diabetics. 2. Maltivessel CAD treated with medicated stents - acute & long term outcome. 3. Renal & corotid stenting with distal protection devices. | ||
| APPOINTMENTS 1992 - 1997 | ||
| MARCH 1992 | : | Appointed Cardiology co-ordinator at the 300 beded Multi speciality Hospital affliated with Tufts University, Boston - The Lilavati Hospital & Medical Research Centre, Bandra Reclamation, Bombay. |
| 8TH APRIL 1992 | : | Held workshop of complex Angioplasties with Prof. Alain Criber from France at the Breach Candy Hospital and Medical Research Centre, Bombay. |
| 1992 | : | Held two research projects entitled (A) BMV by using the Twin AT catheter (B) Decrease myocardial ishemic injury with sequential coronary occlusions in PTCA at the Lilavati Hospital and Medical Research Centre, Bandra Reclamation, Bombay. |
| 1992 | : | Appointed Member of the Executive Committee of the Nuclear Cardiological Society of India. |
| 1992 | : | Appointed Consultant Cardiologist at the King Faisal Specialist Hospital & Research Centre, Riyadh - the exclusive territory care hospital in the Kingdom of Saudi Arabia catering to the King & The Royal family. |
| 1992 | : | Appointed Honarary consultant cardiologist at the Saifee Hospital and Noor Hospital, Bombay. |
| 1992 | : | Appointed Consultant Cardiologist in the Cath Lab at the Breach Candy Hospital & Research Centre Bombay. |
| 1993 | : | Proprietor & Chief of Medicare Diagnostic Services with 2 - D Echo cardiography, pulsed Colour Doppler study, ECG, Holter Monitoring, Computerised Stress Test, X-Ray and Executive Health check-up Schemes available. |
| 1993 | : | Appointed on the panel as a referral cardiologist to Air India, Siemens, E. Merck India Ltd., Pieco Electricals and Electronics, Shaw Wallace and Standard Chartered Banks, Bombay, India. |
| 1992 - 1996 | : | In Private practice as consultant Interventional cardiologist with a fairly large practise performing angiographies, coronary Angioplasties, Rotablator, Intracoronary Stent implantations etc. Perform cases independently and also assist colleagues in interventional procedures at the Breach Candy & Lilavati Hospital, Bombay. |
| 1994 | : | Visiting consultant Interventional cardioligist at the Mafraq Hospital, Abu Dabhi, Tawan Hospital, AI-Ain, UAE. Conducted CME programme & gave lectures in Invasive Cardiology. |
| : | Appointed as a consultant Cardiologist & member of the advisory Board at the Guru Nanak Hospital, Bombay. | |
| 1994 | : | Visited & worked in the Cath Lab on complex angioplasties at the Escorts Heart Institute & Research Centre, new Delhi, India. |
| April 1995 | : | Appointed Consultant Interventional Cardiologist to Shaw Wallace & Company Ltd. |
| May 1995 | : | Acquired Certification of participation & Hands on experience at the Rotablator Physician Training Course at the Escorts Heart Institute, Delhi headed by Dr. David Warth from Seattle, Washington. |
| May 1995 | : | Attended & participated the 6th Complex Coronary Angioplasty course in Tolouse, France |
| June 1995 | : | Acquired special Hands - on training for 3 weeks on Intracoronary Stent Implantation with Prof. Alain Criber at the University Hospital, Rouen, France working independently. |
| September 1995 | : | Appointed member of :
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| September 1995 | : | Appointed Hon. Visiting Cardiologist to H. A. M. Memorial Hospital & Research Centre, Gauhati, Assam. |
| September 1995 | : | Appointed consultant Cardiologist (on the staff) at the Lilavati Hospital & Research Centre, Bombay. |
| November 1995 | : | Created affliations with Prof. John Smith of New England Medical Centre, Tufts University, Boston to work on complex interventional procedures & have joint Research ventures on coated stents. |
| December - January 1996 | : | Visited Cath Lab of Mass. General Hospital, Boston, USA for updating on newer trends in Invasive Cardiology. |
| February 1996 | : | Set up a Aviation clinic at Seeb Airport, Muscat, S. of Oman. Involved in updating a specialized cardiac Unit at Rusayl Health clinic in Muscat. |
| March 1996 | : | Appointed as visiting consultant Cardiologist at the Al-Zahra Hospital, Sharjah, UAE. |
| March - April 1996 | : | Conducted CME Programmes by lectures on Invasive Cardiology at New Dubai Hospital, Dubai & Kuwaiti Hospital, Sharjah, UAE. |
| February - April 1996 | : | Lectures to Senior Citizen clubs of YMCA, Cricket club of India, Priya Darshani Joggers, Prabhadevi Club, General Practitioners Association of Greater Bombay & SNDT University, Bombay for public education on angioplasties. |
| July 1996 | : | Appointed as Visiting consultant cardiologist at Al Amal Medical Centre, Mutrah, S. of Oman. |
| August 1996 | : | Delivered a lecture on "Recent Advances In Inter- ventional cardiology" organized by "Indian Ass of Occupational Health". |
| December 1996 | : | Participated actively in Asia Pacific Meeting in Interventional Cardiology, Chennai, India. |
| January 1997 | : | Conducted lecturers and workshops on Heart Diseases for Gen Practitioners and Consultants at Al Amal Medical Centre, Muscat, S of Oman. |
| February 1997 | : | Delivered a lecture at the National Sports Club Of India on "Prevention and treatment of Coronary Artery Disease" for the Club Members and general public. |
| March 1997 | : | Conducted 2 day training workshop for Executives and technical staff of Johnsons & Johnson in Invasive cardiology in Mumbai. |
| March 1997 | : | Delivered a lecture on "Prevention & Management Of Heart Disease" at the Lilavati Hospital, Mumbai, sponsored by Ranbaxy Labs. |
| April 1997 | : | Invited as a Discussant on panel "Tips & Taps Stent Embolization" at the National PTCA Registry, Delhi. |
| April 1997 | : | Appointed on the Editorial Advisory Board of the bimontly cardiolgy Journal "Cardiolgy Today" |
| April 1997 | : | Conducted a CME programme on "Update In Stents" At Al Amal Medical Centre, Muscat, S of Oman. |
| May 1997 | : | Delivered a lecture on "Update In Stents - A Break - Through Technology In Interventional Cardiology" at The Agha Khan Hospital, Nairobi, Kenya. |
| May 1997 | : | Participated actively in the "Endovascular Therapy Course - Coronary & peripheral" In Paris. France. |
| July 1997 | : | Publication on "Angioplasty In The Treatment Of Coronary Artery Disease" in the Urdu Newspaper Inqallab. |
| August 1997 | : | Press release on my work in interventional cardiology published in the Gulf News & Khaleej Times in UAE. |
| August 1997 | : | Conducted a CME programme and Cardiac Camp at the KESCH Keluskar Medical College, Alibag, district Raigad, Maharashtra. |
| September 1997 | : | Appointed as an Invasive Cardiologist at the Indo- American Cardiovascular Centre, Sir H N Hospital, Mumbai, India. |
| September 1997 | : | Delivered lectures & conducted workshop on "Update in Stents" and "International Cardiology in the 21st Century" at The Annul Conference Of The Kenya Medical Association, Mombasa Kenya. |
| September 1997 | : | Conducted "Cardiac Camps" at the Agha Khan Hospital, Mombasa, Kenya, at the Nasal Puree Memon Jamat Clinic, Mombasa, Kenya & at the Memon Clinic, Nairobi, Kenya. |
| Jan. 1998 - Sept. 2001 | : | Conducted several public and Community oriented education programmes on "Prevention of Heart Disease" and "Free Cardiac Camps" for Asians in Nairobi, Mombasa, Dar-Es-Salaam, Arusha, Mwanza, Eldoret, Mauritius, Madagascar. |
| May 2000 | : | Actively participated in the Paris Course on Percutanious Coronary Revascularization, Paris, France. |
| March 1999 to Sept. 2001 | : | Conducted "Free Cardiac Camps and Community oriented lectures on "Prevention and treatment of Heart Disease" for several Parishes - I.C. Colony, Borivali Parish, Orlem Parish, Chembur Parish, Dubai Parish. |
| August 2000 | : | Guest Speaker at the "Coronary Intervention - 2000" Conference in Nairobi, Kenya. |
| Jan. 2000 - Sept. 2001 | : | Conducted Free Cardiac Camps and Community oriented lectures for "Aga Khan Foundation in North Gujarat, Jogeshwari, Dahisar, Dubai, Toronto, Houston, Madagascar, Dar-Es-Salaam, Mombasa. |
| October 2000 | : | Actively participated in the Transcatheter Conference on Angioplasty, Washington DC, U.S.A. |
| October 2000 | : | Conducted Community Service Programmes for Gujarati Asians in Bolton, United Kingdom. |
| November 2000 | : | Appointed on Medical Advisory Community of SEVA Foundation, Kirtilal Mehta Trust. |
| December 2000 | : | Conducted Cardiac Camps in Kutch - Bhuj, Mandvi, Gandhidham in association with Oswal Jain Trust. |
| Oct. 1998 - Sept. 2001 | : | Served the Khoja Shia Ishthashiri Community with Free Cardiac Camps in Bandra, Nairobi, Dar-es-Salaam, Mombasa, Toronto, Dubai, Mwanza, Madagascar. |
| August 2001 | : | Chairperson and Guest Speaker at the "Vascular Intervention 2001" at Superstar Virgo Cruise, Singapore |
| Jan. 2000 - Oct. 2001 | : | Active in practice as a senior Interventional Cardiologist performing 50 - 60 interventions per month in different cath labs in Mumbai. |
| November 2001 | : | On the National Faculty and Chairing Angioplasty Sessions at the Indo-French Interventional Cardiology meeting in Rouen, France. |
| December 2001 | : | Chairing sessions on 'RcoPro versus Integrilin at the Annal cardiological Society of India conference, Hyderabad, India. |
| Oct. 2001 - April 2002 | : | Conducted CME on "current concept in management of Heart Disease" with audiovisual presention on Newer Interventions in the cath lab to medical associations in Mumbai Bhibandi, Vashi and CBD, Western Suburbs APT, Bandra-Khar Medical Association, Mumbai. |
| January 2002 | : | Actively participated at the Asia Pacific meet in Interventional Cardiology and Singapore live course on Complex Angioplastics, Singapore. |
| February 2002 | : | Convenor of Scientific programme and Guest speaker on "current concept in the management of Heart Disease pertaining to occupational Health" at the 53rd Annual conference of occupational health, Goa, India. |
| May 2002 | : | Actively participated at the 25th Annual Scientific sessions of society for cardiac Angiography and interventions and Interventions, Seattle, Seattle, WA, USA. |
| May 2002 | : | Active participation at the Paris Course on revascularization 2002, Paris France. |
| June 2002 | : | Delivered a lecture on current concepts in Management of cardiovascular Disease' at the Association of Physicians of Tanzania (APHTA) meet, Dar, Tz. |
| July 2002 | : | Delivered a lecture on "Controversies in PCT" as a Interventional Guest Faculty at the Indo-European Cardiology meet, Sun city, Johenesberg, South Africa. |
| August 2002 | : | Passed the Dubia Health Authotrity lisence topractice as Visiting Consultant, Interventional Cardiologist, Dubai UAE. |
| August 2002 | : | Appointed at the Welfare Hospital, Dubai as a Visiting Consultant, Interventional Cardiologist, UAE. |
| August 2002 | : | Delivered a lecture on "Recent Concepts in the Management of Cardiovascular disease" for the Santacruz Medical Association, JW Mariotte Hotel, Juhu, Mumbai. |
| August 2002 | : | Conducted a free cardiac camp at KVOJ Hospital, Bhuj, Kutch, a lecture on "Prevention and Treatment of Heart disease". Rotary Club, Gandhidham, Kutch and Interviewed the press and Gujrat TV on Newer Non Surgical Methods of Treatment of Heart Disease. |
| August 2002 | : | Actively participated at the European Society of Cardiology Conference at Berlin, Germany. |
| October 2002 | : | Presentation on "Update on Heart Disease in Diabetics" at the APHTA (Association of Private Hospitals of Tanzania) conference, Dar-Es-Salaam, Tz. |
| November 2002 | : | Presentation on "Update in Prevention & Treatment of Heart Disease" to Aga Khan Community, Doha, Qatar. |
| February 2003 | : | Appointed as visiting specialist cardiologist at the Belhoul European & Apollo Hospital, Dubai, UAE. |
| April 2003 - January 2004 | : | Presentation on "Update in Prevention & Treatment of Heart Disease" to PNB Paribas Bank, Dubai, DEWA, (Dubai Electric & Water Association) Dubai, Fujeirah Medical Centre, Fujeirah, TEXMAS (Textile Association), Dubai, Dubai Memon Forum, Pakistan Professional Association, Dubai Bhatia Community, Konkan Association of Dubai, Lutfi Group, Dubai, Goa Dubai Muslim Association, Haryana Cultural Group, Ajman Indian Association, Ennoc staff, Dubai, Al Abhas Group, Chartered Accountant Association, Dubai Petroleum Corporation, Irani Club, Indian Women Association, Goodhealth Insurance, MC Dermott, Friends of Yoga General Practitioner of Dubai, FM Radio talk show, Dubai. |
| Nov. 2003 - Dec. 2004 | : | Lisenced to practise Interventional Cardiology in Kenya. |
| November 2003 onwards | : | Performing Cath Lab procedures at Nairobi Hospital, Nairobi on regular monthly visiting agreement. |
| January 2004 | : | Moderator of live course on "Update on Drug Eluting Stents - Indian perspective" chaired by Dr. Patrick Serruys, Hyatt Regency, Mumbai, India. |
| March 2004 | : | Attended and actively participated in the live course On complex angioplasties in Shanghai, China |
| April 2004 | : | Conferred fellowship of theAmerican Society of cardiac Angiography & Intervention in San Diego, CA at the Annual meeting of the SCA&I |
| June 2004 | : | Conducted Continues Medical Education programmes for doctors and the community on 'Current Concepts in Management of Heart Disease' in Arusha, Dar es Salaam, Kampala and Mombasa, East Africa. |
| June .2004 - May 2005 | : | Established 'City Point International Medical Centre' at Dubai, UAE with a state-of-the-art cardiac lab and non-invasive laboratory. |
| Jun. 2004 - Oct. 2005 | : | Conducted patient education seminars on 'Recent update On Prevention & treatment of Heart Disease' in Dubai, UAE for BNP Paribas Bank, DEWA, Mashreq Bank, AL Abbas Group, INOC, British Petroleum. |
| May 2005 | : | Actively participated at the 'American Society of Cardiac Angiography and Interventional conference', Florida, USA. |
| March 2006 | : | Presentation on 'Recent Advances in Interventional cardiology in India' at the Medical Tourism Meet at the ITC Grand Maratha Sheraton, Organised by FICCI - MTMC. |
| May 2006 | : | Actively participated at the 'World Congress in Cardiology' organized by the Australian & New Zealand Society of Cardiology, Auckland, New Zealand. |
| June 2006 | : | Made presentations on 'Recent update in Interventional Cardiology in India' at the Indo-UAE Gulf Summit, Dubai organized by FICCI (Federation of Indian Chambers Of Commerce & Industry). |
| Jan - Oct 2006 | : | Actively involved in setting up a nationwide panel of hospitals and specialists in various super specialties in India and other countries to promote Medical Tourism. |
| Nov - 2006 | : | Actively participated and chaired sessions at the "Vascular Intervention Meet" At Istanbul (Turkey) |
| Jan - 2007 | : | Key note speaker on "New Intervention in the Cathlab in India" at Indo-Saudi Medical Council meet at Jeddah (Saudi Arabia) organized by FICCI and Government Of India and Indian Consulate of Saudi Arabia. |
| Feb - 2007 | : | Key speaker on "Update On Prevention and treatment Of Coronary Artery Disease" for Rotarians and Doctors Of Goa Medical Association and conducted Cardiac camp at Vrundavan Hospital Mhapa Goa. |
| May - 2007 | : | Actively participated at Paris Course on revascularization 2007, Barcelona. |
| October - 2007 | : | Key speaker on "Recent update in Management of Cardiovascular disease" for Doctors of Vapi Medical Association. |
| Nov - 2007 | : | Key speaker on "Recent update in Cardiac Emergencies" for Association of Physician of India (Navi Mumbai Branch). |
| May - 2008 | : | Attended training on IVUS at Hopital Mulitizonale, Varese Italy, with Dr Edvordo Verna in the cathlab on complex coronary interventions with IVUS. |
| June - 2008 Till Date | : | Actively involved in setting up Interventional cardiology academy with simulators & cathlab for live courses and Teaching programs in Interventional cardiology at Vapi, Gujarat India. |
| September -2008 | : | Chaired & Moderated CTO Transradial Conference organized by Dr.Cyto at AIMS-Cochin. |
| Febraury 2010 | : | On Faculty at the JIM metting in Rome, Italy |
| March 2010 | : | Conducted CME to IMA and GPA of Borivali, Kandivali, Jogeshwari, Goregaon, JVPD |
| April 2010 | : | Guest speaker at the Indian Occupational Health on Follow up On coronary stents by the Physician at CCI, BKC, Mumbai |
| April 2010 | : | Faculty At the TCTAP Interventional Cardiology Confernance at Seoul, Korea |
| July 2010 | : | My approach to STEMI 2010, IMA (Indian Medical Association), Western Suburbs, Mumbai |
| July 2010 | : | Trained Technicalities on Trans Catheter Aortic Value implant by Professor Alain Cribier, University of Rouen, France |
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