The following was written by Haseeb Qazi, MBBS, a third-year fellow in Cardiovascular Medicine. We appreciate his willingness to share and his reporting skills!
Scottsdale Interventional Forum (SIF) 2019 was held in Scottsdale, AZ, from March 27–30, 2019. Interventional cardiologists from all over the United States, along with around 81 cardiology fellows-in-training attended this conference. A fellow’s course was also held for interventional cardiology fellows focused on the fundamentals of interventional cardiology and both basic and complex coronary interventions, using a case-based teaching method, live-case transmissions and hands-on modeling workshops.
During the conference, a fellow’s case competition was held for presentations on the most challenging complex cases. Fellows were invited to submit their presentations for review; mine was one of three selected to present at the general session titled “Meet the Next Generation of Experts.” This session was attended by a large audience and was judged by around 6 faculty members. Each case presentation was around 10 mins long followed by 5 mins of Q&A session. I was selected as winner of the fellow’s complex case competition.
My case, “A tale of two valves,” concerned a patient with a history of prior rheumatic mitral stenosis status, post-bioprosthetic mitral valve replacement, who presented with significant heart failure symptoms and was found to have severe mitral stenosis. Her case was complicated by the presence of left-atrial thrombus. She was considered too high-risk for surgery and palliative care vs transcatheter valve replacement was considered. She underwent transcatheter mitral valve-in-valve replacement with cerebral protection device in place.
She did well initially but then presented with right-sided heart failure symptoms. She was found to have severe tricuspid regurgitation. It was a challenging case because she had a prior tricuspid valve repair with incomplete annuloplasty ring, thus she had a possibility of valve embolization. Dr. Sidakpal Panaich successfully placed a tricuspid valve-in-ring procedure with no residual tricuspid regurgitation. It is a very novel technique and only a handful of these have been performed in the country.
Dr. Panaich helped mentor me during the case competition. He was able to help out with the draft of the presentation as well as by highlighting important details of the case. We even brainstormed various questions that faculty might consider asking during the presentation. Surprisingly, some of the questions we thought might be important to the case were raised during the actual competition. Dr. Milena Gebska also helped gather echocardiogram images for the patient.
SIF 2019 Fellows Course Director, Dr. Douglas E. Drachman shared the following with me:
Congratulations on your spectacular presentation and on your selection as the winner of the SIF 2019 fellows’ case competition!
It was clear from your presentation that you knew the patient very well, that you had thought through the underlying physiology carefully, and that you chose the challenging course of treatment considering the risks and benefits in great detail, and with engagement of the patient. Moreover, the presentation was exceptional in its clarity and how definitively you were able to demonstrate the impact of each intervention.
Douglas E. Drachman, MD, FACC, FSCAI
Director, Cardiovascular and Interventional Cardiology Fellowship Programs
Massachusetts General Hospital, Boston