Dr.S.Venkatesan MD

Posts Tagged ‘tavi’

Protecting the Left main from TAVI

Posted in Uncategorized, tagged bassillica, calcification in tavi, core valve, coronary hieght, edward sapien, leaflet lenght in tavi, left main protection after tavi, mvalv, pci after tavi, tavi on June 19, 2026|

TAVI has become a popular Aortic Intervention, but the risk of coronary obstruction (Left main & RCA too) is often underestimated , it can happen during the procedure or in the long term .High degree of anticipation is essential. The exact incidence is not known as reporting the event is far less than, what it is actually. Following are the suggested precautions to prevent coronary obstruction.

Pre-Procedural Assessment

• Low Coronary Ostial Height: Identify if the Left Main origin is (< 10–12 mm )from the aortic annular plane, that will increase  the chance of struts covering the ostia.
• Shallow Sinuses of Valsalva : A shallow sinus( < 30 mm )leaves insufficient room for the displaced native leaflet, directing it toward the ostium.
• Leaflet Length and Calcification: Evaluate for heavy calcification or a long native leaflet that exceeds the height of the coronary ostium, as these are easily pushed into the vessel opening.
• Virtual Valve-to-Coronary (VTC) Distance: In Valve-in-Valve (ViV) procedures, calculate the VTC distance. A computed distance less than 4 mm indicates risk of coronary obstruction.

Risk factors for potential coronary obstruction.

Image source Ref 2

*Leaflet length is a very critical parameter, which was ignored in the past. (It is more Important than even, the coronary height.Mind you coronary height matters little if leaflet is long enough to reach the ostium , when TAVI flushed it with wall of Aorta.)

Intra procedural precautions(In small shallow roots)

• Chimney Stenting: Prophylactic wire in the Left Main and park an undeployed drug-eluting stent. If any segment of TAVI tends to occlude deploy the stent.
• BASILICA/Leaflet Splitting: This is used in ultra-high risk or valve-in-valve cases, use radiofrequency energy or mechanical cutting devices to lacerate the target aortic cusp before valve deployment, forcing it to part like a curtain instead of blocking the ostium.This is not an easy procedure as it may look. Prone for its own complication.

Post-Procedural & Long-Term Management

Dual antiplatelet therapy is critical . Routine echocardiography and follow-up CT angiograms to monitor for delayed coronary obstruction or stent deformation . Documenting the valve-stent alignment is encouraged for a possible future coronary interventions.

Planning a PCI with TAVI

Image source : Ref 2

PCI types in different types of valves. A) PCI with minimal stent protrusion due to limited space between the valve and the STJ. B) Adequate space between the valve and the STJ, allowing for the chimney technique. C) Valve-directed stenting from the coronary ostium towards the valve frame. D) PCI with minimal protrusion, as the coronary ostium is located above the valve. E) Coronary ostium located below the valve frame, with sufficient space between the valve and the STJ to perform the chimney/snorkel technique. F) Coronary ostium located below the valve frame, with limited space between the valve and the STJ; therefore, stenting is directed from the ostium towards the valve. BEV: balloon-expandable valve; PCI: percutaneous coronary intervention; SEV: self-expanding valve; STJ: sinotubular junction; TAVI: transcatheter aortic valve implantation

Final message

TAVI is a popular Aortic Intervention, but the risk of coronary obstruction is often underestimated by cardiologists, and it can happen during the procedure or in the long term; thus, preparedness is essential.

Reference

1.Aquino_bruno.pdf TAVI and coronary interventions: indications, technical considerations, and clinical scenarios Euro Interventions Volume 22 Number 11 Jun 1, 2026

2.https://eurointervention.pcronline.com/article/tavi-and-coronary-interventions-indications-technical-considerations-and-clinical-scenarios

Rate this:

Read Full Post »

Re-learning cardiac anatomy : Aortic annulus is a zone, not a single anatomical plane

Posted in Uncategorized, tagged Aortic annulus, aortic root, cardaic aantomy, height of aortic annulus, Infra annlular tavi, sino tubular junction, supra annular avr or tavi, tavi, virtual aortic annlus on June 3, 2026|

Learning anatomy is foundational first step in the pathway to become a great clinician. This post is written to address a potential nomenclature issue in cardiac anatomy .

What constitutes Aortic annulus.?

“Aortic annulus” by default conveys a discrete, planar, circular ring. However, from a macroscopic and histological perspective, a distinct, single-plane collagenous ring does not exist at the base of the aortic valve. Rather, aortic annulus is a complex, three-dimensional , Morpho-anatomical functional zone spanning the ventriculo-aortic junction. This brings the aortic leaflets to be arranged in a crown-like formation that crosses multiple spatial planes. The lowest points of these attachments (the nadirs) dip into the left ventricular outflow tract, while the highest points (the commissures) extend superiorly to anchor at the sinotubular junction.

 

Can anyone see a single plane of Aortic annulus in the above Image ? Note the leaflets , pan whole area from the virtual ring to the ST junction making the annulus a well secluded zone with from ST junction to the virtual lower ring. This aortic annular zone has clear cut boundaries, the inferior border is formed by lowermost insertion points of the aortic valve leaflets. (Which just above the virtual ring formed by sinus of valsalva)

Why the misconception ?

The misconception of a flat aortic annulus came from  extrapolation of AV valve anatomy to the semilunar valves. In the mitral and tricuspid positions, the leaflets anchor to a continuous,  planar fibrous skeleton. Consequently, their hinge lines and leaflet planes remain the same in a reatively single plane throughout the cardiac cycle.

Systolic and diastolic disconnect

This complex anatomy of aortic annulus also results in a clear disconnect between systole and diastole. During systole, the aortic leaflets open vertically like flushed doors, against the sinus walls , while  the basal plane vanish.Conversely, during diastole, the leaflets fall medially and down to meet at the center, creating a horizontal plane of coaptation.

Timing of measurement of aortic annlus

We are asked to measure the aortic annulus in peak systole. Ironically  at this point of time , every measurement becomes virtual in the aortic annular zone.  At least in diastole, the so called virtual lower end becomes real with leaflets hanging down forming a point of reference.

TAVI and Aortic annulus measuerment

The measurement of the aortic annulus has become essential due to the rise of TAVI, as CT scans accurately define the annulus compared to echocardiography, revealing the distinct height of the aortic annulus that was previously unrecognized. read below, for all the relevant measurements before doing a TAVI.

Image source : Jun-Hyok Oh IJC Heart & Vasculature Volume 37, December 2021, 100917

Newer TAVI engineering designers intentionally utilizes the entire vertical distance of the aortic root (from the leaflet nadirs to the ST junction) to anchor, seal, and position leaflets across different spatial planes to optimize physics and hemodynamics

Final message

The perception of aortic annulus as a single anatomical plane in our minds is very firm and it is due to the flaw in the way we learned cardiac anatomy. To make things right, we need to change aortic annulus as the “aortic annular zone” in anatomical literature. This change must be made at the earliest, right from the first clinical years of undergraduate education. Recognizing this is vital for understanding surgical or percutaneous repair or replacement of prosthetic valves.

Postamble (For the fellows)

When someone asks you what is aortic annular size, please ask them to confirm which dimension they are talking about. If they are surprised, teach them, there are  distinct multiple horizontal (Maximal, minimal) and vertical distance for every annulus.(Which can correlate to a certain extent to the coronary height, the TAVI guys talk about)

---

References

1. Piazzese ED, de Jager SE, van Straten AH, Elenbaas TW, Soliman-Hamad MA. Surgical anatomy of the aortic valve and root—implications for valve repair. Ann Cardiothorac Surg. 2019;8(3):324-331. doi:10.21037/acs.2019.04.09
2. Loukas M, Bilinsky S, Bilinsky E, El-Sedfy A, Anderson RH. The anatomy of the aortic root. Clin Anat. 2014;27(5):748-756. doi:10.1002/ca.22295
3. de Kerchove L, El Khoury G. Anatomy and pathophysiology of the ventriculo-aortic junction. Ann Cardiothorac Surg. 2013;2(1):87-92. doi:10.3978/j.issn.2225-319X.2012.11.15

Rate this:

Read Full Post »

Who decides the final landing spot of TAVI ?

Posted in Uncategorized, tagged annular disruption, basillica procedure, core valve, medtronic resilia, partent study, sapien edwards, supra annular or annular tavi, tavi, tavi landing zone, tavi proctor, TAVR landing zone on September 11, 2025|

A. The Aortic Radiologist

B. The Principal operator of TAVI

C. The co-operator or the proctor

D. The device type, behavior & destiny

Answer : A. The radiologist, (rather the soft-warist ) tell us best landing zone in the pre procedure work up taking into the account of shape, size, leaflet morphology ,3D analysis of aortic root, and calcium distribution. He plays a vital role. Though B, is the logically correct answer, ie the expertise of the primary Operator it is not to be. Considering the complexity of the anatomy, device, and momentary longitudinal and circumferential alterations in radial forces, In reality, the answer is D.

Evidence? No one has tested so far the true intended landing zone and the final one.

---

One may argue , the question need to be reframed as, What are the factors that decide the landing zone in TAVI ?

Though deployment is under the control of primary operator , the valve often defies operators’ hand commands and decides to home in its own place of comfort and peace adjusting to the complex anatomy around. It never bothers about the consequences .The unpredictability of calcium crystals, the annular tensile strength, the distorted native leaflet and the blind plastering against the aortic wall all are responsible for the complications. One less talked dynamism of aortic root which finetunes micro adjustments of the valve. Para valvular leak is primarily determined by either excess (or lack )of this modulatory forces.

Following are some of the crucial factors that determine landing zone.

Anatomy of the Aortic root

 The ascending aortic curvature and angulation is a major factor of the TAVI landing site. , stretching from the aortic annulus to the proximal ascending aorta. This anatomy may vary depending on the patient and affects different types of valves (such as balloon-expandable or self-expanding). For instance, higher aortic angulation (Ex – a horizontal aorta) can influence the final depth of valve implantation, especially for self-expanding valves with longer stent frames.

The invisible radial & longitudinal forces

The resistance offered by the distorted native valve and its delicate balance with the instant radial force of in case of balloon expandable or the gradual built in force of self expandible balloon system. Apart from the radial forces. the longitudinal deformation forces in long axis as the stent expands , in the last few seconds determine the final residence of the valve.

Valve Type and Device Design

The intended implantation depth is usually planned based on the valve type—balloon-expandable valves have a short stent frame and are deployed differently than self-expanding valves with a taller frame. More precision is required in balloon expandable valves. This is because the anchoring mechanisms and the metallurgy is entirely different between the two.(SE-TAVI uses Nitinol frame, and it has wide contact area so more stable ,)

Intra-Procedural Adjustments: 

The final landing zone is also influenced by the need to avoid complications such as valve migration, aortic regurgitation, and coronary obstruction.

Final mesage

Some times, TAVI landing looks like SpaceX Dragon docking with a space station. Extreme precision is required to avoid complications. The bulk of the complications are due to inappropriate landing (too high or too low). Fortunately, aortic annulus exists in multiple transverse planes; patients can often tolerate some geographical miss. Still even a few mm error can crash the patient as well as our reputation.

Postamble

What are the chances of immediate post -procedural movement and late migration of the valve from the landing site in TAVI ?

The chances of immediate post-procedural movement and late migration of the valve from the landing site in Transcatheter Aortic Valve Implantation (TAVI) are generally low but represent serious complications when they occur. Incidence is up to 7.5%

Reference

https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.928740/full

* Video source and courtesy

Rate this:

Read Full Post »

What are the various 3D-CT soft-wares available for pre-procedural TAVR Imaging ? How accurate they are ?

Posted in Uncategorized, tagged 3mensio, comparison of various ct scan tavi software, cvi42, free tavr tavi soft ware ct scan, heart navigator, horos tavi tavr soft ware, intution tavr planning, osirix md, partner, sapiens vs core valve, syngo vs 3mensio, tavi, tavi software, TAVR, vitrea ct scan tavr tavi on August 11, 2025|

TAVI is becoming like PCI equivalent of aortic valve. The procedure is nothing but stenting and plastering the aortic prothesis ,with all the native diseased aortic leaflet in-situ. Pre procedure CT aortic valve mapping (rather the entire Aorta) is the key to successful outcome.

While the calcium is the essential bonding force of the valve to the aortic annulus, it can also play some serious spoilsport, along with native leaflet debri . Many times, the hardened calcium are like like sharp 3 dimensional knife hanging over there in root of aorta.

Every TAVI operator has this ligering fear . Will that speck of calcium “ice berg”, hiding 2 mm above the NCC, hit the AV node, when I deploy the valve ? Will the distorted leaflet jump few mm above and hit the coronary ostia , however high it may be. (After all , the exact final landing zone is not determined by the operator , but by the ROC curve)

Every severely calcified valve experiences a Titanic effect , fortunately most valves escape.

Realise how important the accuracy these softwares are .It is just a matter of few mm error . . Apart form calcium distribution pattern , more fundamental parameters like the annular size, shape, and optimal imaging angle are critically important. Here is brief report on various software packages available for pre procedure planning of TAVR.

Image courtesy : Thoracic Key  Assessment of aortic valve calcification.The stretch view shows dense calcification of the right coronary cusp, noncoronary cusp, and left coronary cusp. The stretch view (A), angiographic overlay (B), cross-sectional view (C), and “hockey puck” view (D) allow quantification of the calcium in the aortic valve.

The following table was curated from the respective company websites. Any further details can visit them.

Software	Vendor/Developer	Key Features for TAVR Pre-Planning
3mensio Structural Heart	Pie Medical Imaging	Dedicated TAVR module for automated aortic root analysis, valve sizing, and access route planning. Provides 3D visualization, calcium scoring, and virtual valve implantation. Widely used for precise measurements and procedural simulation.
OsiriX MD / Horos	Pixmeo (OsiriX) / Open-source (Horos)	DICOM viewer with 3D multiplanar reconstruction (MPR) tools for manual valve sizing, annulus measurement, and aortic root analysis. Horos is a free alternative. Supports plugins like ProSizeAV for semi-automated sizing.
syngo.via CT Cardiac Function – Valve Pilot	Siemens Healthineers	Semi-automated workflow for aortic valve assessment, angulation prediction, and device sizing. Includes valve pilot tools for efficient CT analysis.
HeartNavigator	Philips Healthcare	Automated or semi-automated CT processing for TAVR, including aortic root segmentation, access route simulation, and procedural guidance. Often compared for reliability in measurements.
Valve Assist 2	GE Healthcare	AI-assisted tool for valve sizing, CT analysis, and planning efficiency. Focuses on automating measurements to reduce manual effort.
Mimics Enlight / Mimics Planner	Materialise	Cloud-based 3D modeling software with automated workflows for structural heart interventions, including TAVR-specific measurements, virtual valve implantation, and 3D printing support. Includes AI for segmentation.
cvi42	Circle Cardiovascular Imaging	Advanced CT tools for interventional planning, including TAVR, with automation for aortic valve assessment, flow quantification, and structural heart disease management.
Intuition TAVR Planning	TeraRecon	Comprehensive package for aortic root segmentation, centerline extraction, and pre-operative measurements. Supports advanced 3D/4D visualization for TAVR workflows.
Vitrea CT TAVR Planning	Canon Medical (Vital Images)	AI-leveraged application for automated TAVR assessment, including valve sizing, access planning, and post-operative evaluation. Integrates deep learning for efficiency.

Some questions

1.Which one is most popular ?

With out doubt 3mensio is top software because of its neutrality between various TAVR valve and wide spread usage and comparisons.

2.What is the cost of these software ?

They are substantial has a monthly subscription model. 3Mensio pricing starts at approximately $500/month for 1 user, $4,000/month for 10 users.

3.Is there any Freeware for assessing Aortic root ?

Yes . OsiriX MD / Horos is a free ware, but not getting sufficient attention.

4.What is the error rate of these software ? since they are offline and often images are machine extrapolated ?

Error rate in software are well not reported. (Can’t expect the vendors to do it !) However, It must be acknowledged they are real because of the offline nature of image processing .These tools process DICOM data, in pre-trained algorithms. Errors can arise from poor CT input (e.g., motion artifacts) or extrapolation in 3D reconstruction (e.g., interpolating between slices), but studies show minimal impact with high-quality scans.

Common Error Sources: User variability, calcium blooming artifacts, or phase-specific differences in dynamic CT.

Clinical Implications: Errors in sizing can lead to complications like paravalvular leak (if undersized) or embolism (if oversized), but validation shows risks are low (e.g., <2 mm differences rarely affect outcomes). Multi-reader or expert double check is encouraged to improve accuracy.

Rate this:

Read Full Post »

Early TAVR trial : Too early to call

Posted in Uncategorized, tagged acc, accurate neo tavi, aortic valve repalcement, bmj, early tavr nejm, esc, ethics, how end points of a study defined?, lancet, medical statistics, primary endpoints, sapiens core valve, stsscore, tavi, tavr for asymptomatic, tavr vs surgery on January 18, 2025|

We know TAVI is in the striking distance , to literally take over most aortic valve interventions. From a humble beginning from very high surgical risk with prohibitive comorbidity, now it has almost touched the totally asymptomatic, relatively morbid-free patients. Thanks to the hardware, expertise, and motivation from multiple forces.

While the numbers increase, still the debate between SAVR and TAVR is riddled with speculation, skepticism, and absolute confidence. (Reason: TAVI is a passively fixed valve in a blind procedure at a self-selected annular plane, with no option to remove the crushed native leaflet debris and the resultant complications. Lastly, TAVI’s lifespan* is currently less than half of a mechanical valve. *Expected to improve with polymer valves)

The latest trial to join the litereture is EARLY TAVR in October 2024

Here is a brief, personal comment about the paper for non-academic consumption. Look carefully at the 15th second of the video. Pause it, look at the number over there on the bar of unplanned hospitalisation.

It is a staggering 41.7% in clinical surveillance group, twice more than TAVI group, pathologically tilting the conclusion of the study.

Video source and courtesy https://youtu.be/3wwQEEG4aWg

By the way, what is that unplanned hospital admission? Who is planning that admission in the asymptomatic control group? If 41% of people in the clinical surveillance group needed hospital admission, what does it mean? Does that mean clinical surveillance was so poor that they were rushed to the hospital despite being asymptomatic and stable in the surveillance period?

Why should totally asymptomatic patients get admitted in the control arm, in such huge numbers? You can presume what could be the reason. My guess is too sinister.

Another issue plaguing the RCTs for decades, is continuing even in 2025. That is putting together death, stroke, and unplanned hospital admission as a combined endpoint in the same basket. This is the familiar old cheat story i.e., used to intentionally torture the truth.

Final message

Any student with basic sense of statisitcs can interpret the result of this landmark trial from NEJM correctly. The question we need to ask is, what are the triggers for those unplanned hospital admissions?

Further, it is good for NEJM (and the medical community) not to accept any papers, if the studys’ endpoints are not appropriate or defined with the intention to manipulate, which happens in many sponsored trials.

Rate this:

Read Full Post »

A Pacemaker quiz and a new concept.

Posted in Uncategorized, tagged chb after tavi, chb risk with tavi, core valve vs sapien, how to use a permanent pacemaker as temporary ?, how to use a ppm as tpm?, mechansim of chb after tavi, tavi, TAVR on April 22, 2024|

This image comes with courtesy of the Journal of SCAI Jai Parekh, Vikram Sharma, Jared Robl,et al Journal of the Society for Cardiovascular Angiography & Interventions 3 (2024) 101310

What is your diagnosis ?

I thought, it was pacemaker extrusion. It was indeed a close answer, still terribly wrong. It is an intentional exterior placement of a permanent pacemaker generator mimicking an extrusion due to pocket infection. Here is a patient, where a permanent pacemaker was kept temporarily for a few weeks or a month in high-risk reversible complete heart block situations. This typically occurs after an inferior posterior myocardial infarction, drug-induced CHB.

Currently, with the arrrival of TAVR, CHB has beceome a glamorous complication and is getting wider attention. This happens due to the anatomical uncertainties where the inferior landing zone of TAVI is pre-destained and is beyond our control. This is more true in the self expanding Core valve platform . When the lower edge treaspass the non-coronary cusp- membranous septal junction, it hits perfectly the compact post-penetrating bundle of His, confering a high risk of CHB.

Still, the good thing is some of them recover as the pressure edema regress .Putting a PPM in all such patients was considered mandatory or even a vanity in the past. Now we realise it is an additional metallic luggage in an already strained heart, Temporary-PPM the oxymoronic innovation is perfect option in this setting.

Final message

A typical external temporary pacemaker can be kept for up to 2 weeks maximum. (We have kept it for a month or so) It’s done via the jugular, subclavian, or even femoral. If the underlying condition demands more time for recovery of CHB, many do a regular permanent pacemaker.

Now , we have this unique option of using PPM as TPM. This is not a new concept though. It was used few decades ago .Has come back in more centers .Thanks to TAVI and its specific complications.

Reference

1.Rodés-Cabau J. Ellenbogen K.A. Krahn A.D. et al. Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019; 74: 1086-1106.

2. Leong D, Sovari AA, Ehdaie A, Chakravarty T, Liu Q, Jilaihawi H, Makkar R, Wang X, Cingolani E, Shehata M. Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement. J Interv Card Electrophysiol. 2018 Jun;52(1):111-116. doi: 10.1007/s10840-018-0345-z. Epub 2018 Mar 12. PMID: 29532275.

Rate this:

Read Full Post »

This PARTNER would give sleep less nights to our cardiac surgeons !

Posted in cardiac surgery, Cardiology -Interventional -PCI, cardiology -Therapeutics, valvular heart disease, tagged edwards sapiens, Partner 2, tavi on May 31, 2012| Leave a Comment »

Cardiologists are  closing in ,  trying to capture the final frontiers. The  trans-cutaneous Aortic valve Implantation now has  a two year follow up. (NEJM March 2012  Issue) . The results are encouraging .

While two companies are fighting for the supremacy in TAVI ,   the real  threat is for the cardiac surgeons. Currently Edward  Sapiens  has an edge over Medtronic core valve as it  has a provision to redeploy or fine-tune the  final geo- position.

Reference

PARTNER 1

PARTNER 2

Medtronic core valve

Open access  article  by Martin Leon

http://www.rmmj.org.il/userimages/22/1/PublishFiles/25Article.pdf

Rate this:

Read Full Post »

• Search for:

• Categories

  Categories Select Category acute aortic dissection  (1) acute coroanry syndrome  (18) acute coronary syndrome  (24) acute pulmonary embolism  (5) acute rheumatic fever  (5) admixture lesions in cyanotic heart disease  (1) Alcohol and heart disease  (1) Anatomy of heart  (9) angina  (1) anti platelet drug  (4) aortic aneurysm  (1) Aortic diseases  (10) Aortic regurgitation  (3) aortic stenosis  (5) Aortic stent grafing  (2) Aortic valve replacement  (2) ASD device closure  (1) atherosclerosis  (2) Atrial fibrillation  (13) Auscultation  (2) Awards in medicine  (1) baloon aortic valvotomy  (1) Basic sciecne  (2) Basic science -Physiology  (3) bav vs tavr  (2) Best books in cardiology  (6) Beta Blocker  (1) bifurcation pci  (1) bio ethics  (83) Blood pressure  (1) Breakthrough technology  (1) Bronchail arterial and venous circulation  (1) bronchial arterial and venous circulation  (1) Brugada syndrome  (6) CABG  (1) CABG for Ischemic DCM  (1) CABG Indications  (1) CAD in HFpEF  (1) cardaic pharmacology  (1) cardaic physiology  (28) cardiac anatomy  (3) Cardiac biomarkers  (1) cardiac cycle  (1) cardiac drugs  (32) cardiac electrophysiology  (2) cardiac embryology  (2) cardiac failure  (10) Cardiac MRI  (4) Cardiac myxoma  (1) cardiac physiology  (31) cardiac radiology  (3) cardiac resynchronisation  (2) cardiac source of embolism  (1) cardiac surgery  (61) cardiac tamponade  (1) cardiac volume  (2) cardiac X ray  (1) cardinal symptom in cardiology  (2) Cardio Nephrology  (2) cardio pulmonary resucitation  (1) Cardiologt women  (3) Cardiology – Animations  (10) Cardiology – Clinical  (353) Cardiology – Electrophysiology -Pacemaker  (87) Cardiology – Pioneers  (2) Cardiology -Clinical signs  (4) cardiology -congenital heart disease  (40) Cardiology -Coronary collateral circulation  (1) Cardiology -Criteria  (4) Cardiology -Definitions  (3) cardiology -ECG  (147) Cardiology -Emerging technology  (3) Cardiology -Funny events  (1) Cardiology -guidelines  (21) Cardiology -Hemodynamics  (8) Cardiology -Interesting videos  (1) Cardiology -Interventional -PCI  (260) Cardiology -Mechnisms of disease  (15) Cardiology -Non coronary Interventions -PTMC  (2) Cardiology -Pacemakers and ICD  (5) Cardiology -Patient page  (5) cardiology -pregnancy  (2) cardiology -Preventive  (8) cardiology -Sexual health  (2) Cardiology -Technology  (5) Cardiology -Therapeutic dilemma  (34) cardiology -Therapeutics  (308) Cardiology -unresolved questions  (277) Cardiology classics  (5) cardiology congenital heart disese  (23) Cardiology hypertension  (15) Cardiology Illistrations  (1) Cardiology Illustrations  (2) cardiology innovation  (15) Cardiology Innovations  (4) cardiology journal club  (13) Cardiology journal links  (2) cardiology journals  (21) Cardiology lipids /dyslipidemia  (4) Cardiology Outcome analysis  (1) Cardiology Patho physiology  (2) cardiology physiology  (2) Cardiology quotes  (18) Cardiology research topics  (6) cardiology research topics for fellows  (2) Cardiology Risk assesment  (9) Cardiology teaching websites  (4) Cardiology therapeutics  (1) cardiology thesis topics  (1) cardiology wisdom  (6) cardiology women  (3) cardiology- coronary care  (127) cardiology-Anatomy  (32) Cardiology-Arrhythmias  (66) Cardiology-Coronary artery disese  (93) Cardiology-Echocardiography  (4) Cardiology-Electrolytes  (1) cardiology-ethics  (58) Cardiology-Land mark studies  (41) Cardiology-Statistics  (5) cardiomyopathy  (5) carotid interventions  (3) Cath lab Hardware  (3) cath lab tips and tricks  (28) Centre for cardiology unlearninng  (1) cerebral circualtion stroke  (3) cerebral circulation stroke  (3) Chest pain  (1) Chronic total occlusion  (1) chronic total occlusion (CTO)  (1) Clinical cardiology  (58) Clinical cardiology  (7) Clinical cardiology -Cyanosis  (2) Clinical cardiology -JVP  (2) clinical cardiology -Murmurs  (1) clinical lipidology  (1) coarctation of aorta  (1) Comparative efficacy  (1) Complete heart block  (1) congenital heart disease  (3) constrictive pericarditis  (1) constritctive pericarditis  (1) contrast induced nephropathy  (1) Coronary angiogram  (1) Coronary collateral circulation  (1) coronary sinus anatomy and physiology  (1) coronary sinus filling and emptying time drsvenkatesan  (1) coronary veno occlusive disorder  (1) coronary venous circulation  (1) cost effectiveness in cardiology  (2) Criteria and Nomenclature  (1) critical care ccu  (8) cto chronic total occlusion  (5) Diabetes and Heart  (5) Diastolic dysfunction  (3) Dilated cardiomyopathy  (5) Dissection coronary  (1) dr s venkatesan -Personal  (6) dynamic auscultation  (1) dyslipidemia  (3) early repolarisation syndrome  (3) ECG -Basics  (1) Echo library and gallery  (15) echocardiography  (64) Echocardiography – LV dysfunction  (4) Echocardiography -Normal measurement  (2) Echocardiography-hemodynamics  (4) Echocardiography-Limitations of LV EF %  (1) Electro physiology  (4) Electrocardiography-ECG  (1) Electrocardiology -Basics  (1) Electrolyte and Heart  (1) Electrolytes and heart  (1) Embryology : Heart valve development  (2) embryology of heart  (2) emotion and cad  (1) ESC ACC Guidelines  (1) Ethics in Medicine  (16) evidence based cardiology  (4) excercise stress test .EST  (3) fame study ffr  (2) Fracional flow reserve  (2) Future cardiology gadgets  (2) future of cardiology  (1) Futuristic cardiology  (1) Gender issues in medicine  (1) general medicine  (11) great cardiologists  (1) great illustrations in cardiology  (4) Great Men in cardiology  (2) Great men in Medicine  (1) Great websites in cardiology  (13) Hadwares in cardiology  (2) Hardware techniques tips  (9) health economics  (1) Heart failure with preserved LV EF  (1) Heart transplantation  (2) Heart valves  (1) Hemodynamics  (15) Hemodynamics  (1) hemodynamics during Labor  (1) Heparin  (1) HFpEF  (1) HFrEF vs HFpEF  (1) Hippocratic oath  (3) history of cardiology  (23) Histroy of medicine  (6) hocm hcm  (2) hyperlipidemia  (2) Hypertension  (5) hypertrophic cardiomyopathy  (3) ICD  (1) ICD -Tips and Tricks  (2) ICD and Pacemakers  (3) infective endocarditis  (2) Infective endocarditis : Pathology  (1) Infrequently asked questions in cardiology (iFAQs)  (182) innovations in cardiology  (3) Interesting case study  (1) Interventions -Structural heart disease  (1) ischemic cardiomyopathy  (2) ivus  (1) IVUS /OCT/NIR  (1) Jugular venous pulse  (2) JVP -Jugualr venous pulse  (1) Land mark articles in cardiology  (4) Left atrial enlargement  (2) Left main disease  (4) Left main stenting -Tips and tricks  (4) lipid metabolism  (1) lipids lipid metabolism  (3) Long and Short QT syndromes  (1) LSCS for heart disease  (1) LV dilatation is diastolic dysfunction  (1) LV function  (1) Medcal research  (5) Medical education  (12) Medical ethics  (14) medical quotes  (43) medical satistics  (4) metabolic support of heart failure  (1) Mitral annulus -Functional mitral regurgitation  (2) Mitral balloon valvotomy  (1) Mitral prosthetic valve-Surgical tips and techniques  (1) Mitral regurgitation  (3) Mitral stenosis  (2) Morality in medicine  (1) Multimodality Imaging  (1) MVPS  (3) My favorite quote  (1) My presentations  (13) myocardial disease  (25) Neuro cardiology  (1) New hardware  (1) Newer cardiac Imaging  (1) Newer hardwares in cardiology  (2) Newer technology  (1) NSTEMI  (2) obesity  (1) open artery hypothesis  (2) opening snap  (1) oral anticoagulants warfarin acitrom  (1) Pace maker Tips and tricks  (5) Palpation  (1) Pathology-Vulnerable plaque  (1) patient education  (1) PCI PTCA Hardware  (6) pericardial disease  (14) pericardial effusion  (1) Pericardium  (3) perioperative risk assessment: Non cardiac surgery  (1) Permanent pacemaker  (2) platelet function  (1) post dilatation  (1) prasugrel  (1) Pregnancy and heart  (5) pregnancy and heart disease  (7) Preoperative evaluation  (1) Preventive cardiology  (3) Primary -PCI  (10) Primary PCI  (12) Primary prevention of CAD  (3) Primary prevention studies  (1) prosthetic valve dysfunction  (2) prosthetic valves  (2) prosthetic valves -Technical issues  (1) PTMC  (2) PTMC -Tips and tricks  (3) Public Health  (4) Public health issues  (4) Pulmonary arterial hypertension  (4) Pulmonary circulation  (3) pulmonary embolism  (1) pulmonary hypertension  (7) Pulmonary vascular resistance  (1) pulmonary vein ablation  (1) quantitative coronary angiogram  (1) Quotes  (15) radial coronary angiogram PCI  (1) Radial Interventions  (1) RBBB vs RVH  (1) RBBB/LBBB  (1) Reperfusion  (2) rf ablation  (1) rheumatic heart disease  (9) Right atrial appendage  (1) Right ventricle  (3) RIsk factors  (1) Science and Religion  (3) side branch jailing  (1) Social medicine  (7) stains and ldl  (1) STEMI  (9) STEMI -Managment  (8) STEMI-Primary PCI  (20) stress doubtamine echo  (1) stroke  (3) Syncope  (6) systemic hypertension  (1) Systolic decapitation in aortic stenosis  (1) TAVR  (2) TAVR /TAVI  (2) tavr tavi  (2) TAVR VS SAVR  (1) Teaching points  (1) Technology  (3) Technology Emerging  (2) TEE-Transesophageal echocardiography  (1) Tetrology of Fallot  (2) Thesis/Research topics for cardiology fellows  (1) Thrombolysis  (9) Thrombolysis -Tips  (3) Tips and tricks in cath lab  (5) Top ten in cardiology  (7) Tutorial in clinical cardiology  (18) Two line sermons in cardiology  (17) Uncategorized  (842) valvular heart disease  (21) Venkat quotes  (15) Venkatesan -Presentations  (1) Viability assessment  (1) vulnerable plaque  (1) Wintage cardiology  (8) wisdom in cardiology  (6) WPW syndrome  (2) X ray  (3)

• 

• The contents of the this blog is being published as Kindle E book , as per the request of many of the readers. Every article will continue to be open source in this site. Again I shall reiterate the book format is not aimed at any commercial intent. It is only to facilitate learning in a single book format Here is the link to book
  https://amzn.in/d/euhL5vu

  • 

• Archives

  • June 2026 (7)
  • May 2026 (6)
  • April 2026 (11)
  • March 2026 (10)
  • February 2026 (8)
  • January 2026 (8)
  • December 2025 (11)
  • November 2025 (7)
  • October 2025 (8)
  • September 2025 (7)
  • August 2025 (9)
  • July 2025 (10)
  • June 2025 (8)
  • May 2025 (9)
  • April 2025 (7)
  • March 2025 (10)
  • February 2025 (4)
  • January 2025 (9)
  • December 2024 (11)
  • November 2024 (8)
  • October 2024 (10)
  • September 2024 (5)
  • August 2024 (5)
  • July 2024 (6)
  • June 2024 (5)
  • May 2024 (4)
  • April 2024 (7)
  • March 2024 (4)
  • February 2024 (8)
  • January 2024 (6)
  • December 2023 (8)
  • November 2023 (13)
  • October 2023 (14)
  • September 2023 (5)
  • August 2023 (6)
  • July 2023 (10)
  • June 2023 (5)
  • May 2023 (5)
  • April 2023 (4)
  • March 2023 (5)
  • February 2023 (2)
  • January 2023 (7)
  • December 2022 (3)
  • November 2022 (5)
  • October 2022 (5)
  • September 2022 (4)
  • August 2022 (3)
  • July 2022 (9)
  • June 2022 (2)
  • May 2022 (1)
  • April 2022 (2)
  • March 2022 (1)
  • February 2022 (3)
  • January 2022 (7)
  • December 2021 (3)
  • November 2021 (5)
  • October 2021 (8)
  • September 2021 (4)
  • August 2021 (6)
  • July 2021 (6)
  • June 2021 (7)
  • May 2021 (5)
  • April 2021 (4)
  • March 2021 (3)
  • February 2021 (6)
  • January 2021 (8)
  • December 2020 (4)
  • November 2020 (5)
  • October 2020 (7)
  • September 2020 (7)
  • August 2020 (10)
  • July 2020 (6)
  • June 2020 (9)
  • May 2020 (9)
  • April 2020 (5)
  • March 2020 (7)
  • February 2020 (3)
  • January 2020 (4)
  • December 2019 (4)
  • November 2019 (6)
  • October 2019 (3)
  • September 2019 (6)
  • August 2019 (3)
  • July 2019 (1)
  • June 2019 (3)
  • May 2019 (2)
  • April 2019 (2)
  • March 2019 (2)
  • February 2019 (4)
  • January 2019 (2)
  • December 2018 (2)
  • November 2018 (2)
  • October 2018 (2)
  • September 2018 (1)
  • August 2018 (2)
  • July 2018 (3)
  • June 2018 (1)
  • May 2018 (3)
  • April 2018 (1)
  • March 2018 (3)
  • February 2018 (3)
  • January 2018 (1)
  • December 2017 (3)
  • November 2017 (3)
  • October 2017 (3)
  • September 2017 (2)
  • August 2017 (2)
  • July 2017 (2)
  • June 2017 (2)
  • May 2017 (4)
  • April 2017 (3)
  • March 2017 (3)
  • February 2017 (5)
  • January 2017 (3)
  • December 2016 (2)
  • November 2016 (5)
  • October 2016 (4)
  • September 2016 (3)
  • August 2016 (5)
  • July 2016 (3)
  • June 2016 (4)
  • May 2016 (3)
  • April 2016 (6)
  • March 2016 (4)
  • February 2016 (3)
  • January 2016 (5)
  • December 2015 (6)
  • November 2015 (5)
  • October 2015 (8)
  • September 2015 (2)
  • August 2015 (5)
  • July 2015 (7)
  • June 2015 (4)
  • May 2015 (6)
  • April 2015 (5)
  • March 2015 (7)
  • February 2015 (15)
  • January 2015 (8)
  • December 2014 (5)
  • November 2014 (9)
  • October 2014 (7)
  • September 2014 (9)
  • August 2014 (5)
  • July 2014 (11)
  • June 2014 (5)
  • May 2014 (4)
  • April 2014 (5)
  • March 2014 (8)
  • February 2014 (8)
  • January 2014 (5)
  • December 2013 (7)
  • November 2013 (7)
  • October 2013 (14)
  • September 2013 (12)
  • August 2013 (15)
  • July 2013 (15)
  • June 2013 (15)
  • May 2013 (15)
  • April 2013 (15)
  • March 2013 (15)
  • February 2013 (15)
  • January 2013 (15)
  • December 2012 (15)
  • November 2012 (15)
  • October 2012 (15)
  • September 2012 (15)
  • August 2012 (15)
  • July 2012 (15)
  • June 2012 (15)
  • May 2012 (15)
  • April 2012 (15)
  • March 2012 (15)
  • February 2012 (15)
  • January 2012 (15)
  • December 2011 (15)
  • November 2011 (17)
  • October 2011 (17)
  • September 2011 (17)
  • August 2011 (21)
  • July 2011 (20)
  • June 2011 (17)
  • May 2011 (15)
  • April 2011 (17)
  • March 2011 (25)
  • February 2011 (20)
  • January 2011 (20)
  • December 2010 (18)
  • November 2010 (21)
  • October 2010 (21)
  • September 2010 (25)
  • August 2010 (20)
  • July 2010 (10)
  • June 2010 (11)
  • May 2010 (19)
  • April 2010 (16)
  • March 2010 (14)
  • February 2010 (22)
  • January 2010 (18)
  • December 2009 (20)
  • November 2009 (20)
  • October 2009 (3)
  • September 2009 (21)
  • August 2009 (19)
  • July 2009 (12)
  • June 2009 (12)
  • May 2009 (11)
  • April 2009 (15)
  • March 2009 (21)
  • February 2009 (4)
  • January 2009 (12)
  • December 2008 (13)
  • November 2008 (9)
  • October 2008 (22)
  • September 2008 (20)
  • August 2008 (16)
  • July 2008 (14)
  • June 2008 (7)

• Blog Stats

  • 6,689,987 hits

• Please give your feed back .

• Click below to see who is watching this website live !

  
• This site will never aim for profit. Still ,this donation link is added at the request of few visitors who wanted to contribute and of-course that will help make it sustainable .

• Please Note

  The author acknowledges all the queries posted by the readers and wishes to answer them .Due to logistic reasons only few could be responded. Inconvenience caused is regretted.