Ahmed AlShehri MD د.أحمد الشهري
@Alshehri_MD
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Interventional Cardiologist , Cardiac CT , TAVR , Structural Interventional Cardiologist. إستشاري القسطرة التداخلية لشرايين القلب وتركيب الصمامات بالقسطرة.
Riyadh, Kingdom of Saudi Arabi
Joined November 2010
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تلبية لدعوة كريمة من الجمعية العالمية للقسطرة في نسختها الخليجية
#GulfPCR
وتمثيلا لمستشفى الملك فيصل التخصصي
@KFSHRC
وجمعية القسطرة السعودية
@SACIS_KSA
, تمت بحمد لله ٫ المشاركة كمحاضر وعضو لجنة في اكثر من محاضرة . الشكر موصول للقائمين على الجمعية
@PCRonline
.
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12
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60 year old male presented with
#NSTEMI
, EF 45% with inferior RWA, Moderate
#MR
!!.
History of severe chest pain for 30 mins 2 weeks ago then subsided , CK normal , troponin 1000 , underwent
#OCT
guided PCI to RCA !!
OCT:Recanalized Thrombus !!!
@bandarh888
@mirvatalasnag
5
13
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55 year old male with intermittent chest pain for three weeks !!!
admitted as a case of UA . Echo shows EF 40% with hypokinesia of anterior wall !!
@DrNataliaP
@mmamas1973
@mirvatalasnag
@yeh_james3
@johaniMD
@tejsheth1
@bader1619
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11
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تلبية لدعوة كريمة من بروف
@MBalghith
وتمثيلا لمستشفى الملك فيصل التخصصي بالرياض، تشرفت بالحضور كعضو لجنة لنقاش علاج الصمام الاورطي عن طريق القسطره التداخلية في مؤتمر الرياض لعلاج مشاكل القلب الهيكليه بالقسطره .الشكر موصول للاخوة المنظمين وعلى رأسهم بروف @
@MBalghith
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Have you wonder what may happen to Microvascular circulation post Rotational Atherectomy to underexpanded two layers of stents and PCI to proximal LAD?.
Notice the FFR , CFR and IMR pre and post then 1 month later !!!
Source:
@PCRonline
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9
45
تلبية لدعوة كريمة من الدكتور وائل القشقري
@AlkashkariWail
وتمثيلا لمستشفى الملك فيصل التخصصي بالرياض، تشرفت بالحضور كعضو لجنة ومحاضر في المؤتمر السعودي لجمعية القسطرة التداخلية
@SACIS_KSA
.الشكر موصول لكافة المنظمين وعلى رأسهم د.ميرفت الاصنج
@mirvatalasnag
7
11
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تلبية لدعوة كريمة من جمعية القلب السعودية
@TheSaudiHeart
وتمثيلا لمستشفى الملك فيصل التخصصي
@KFSHRC
، تشرفت بتقديم محاضرة عن اعتلال تروية الشرايين الوظيفي للقلب في الاجتماع السنوي للجمعية المقام في الرياض .الشكر موصول للاخوة والزملاء المنظمين
@SACIS_SoMe
@SACIS_KSA
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7
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تلبية لدعوة كريمة من الدكتور فواز المطيري
@Falmutairi2018
وتمثيلا لمستشفى الملك فيصل التخصصي بالرياض، تشرفت بالحضور كعضو لجنة ومحاضر في مؤتمر الجمعية الخليجية للقسطرة التداخلية لعلاج صمامات القلب
@GisGulf
المقام في دولة الامارات الحبيبة .الشكر موصول لكافة المنظميين .
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Have you wonder what may happen to microvascular circulation when you perform
@impella
assisted PCI ?
80 Y.O presented with recurrent inferior
@STEMI
,had
#PCI
with Rota. to calcified mid RCA stenosis .
Yuma Hamanaka et al. J Am Coll Cardiol Intv 2019; 13:135-137
@JACCJournals
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1
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55 year old male with intermittent chest pain for three weeks !!!
admitted as case of UA .. Echo shows EF 40% with hypokinesia of anterior wall !!
@DrNataliaP
@mmamas1973
@mirvatalasnag
@yeh_james3
@johaniMD
@tejsheth1
@bader1619
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74 year old post PCI LAD to D across the LAD !! 12 years ago !!! Came with angina despite maximum medical therapy. MPI Anterior wall ischemia with normal EF %.CAG showed
#CTO
occluded LAD-D stent. PCI
#bifurcation
to LAD+ D utilizing
#Orsiro
stents !! Thoughts?.
1
5
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I got one of my complex structural cases ,which was done
@KFSHRC
, accepted for
#PCRLV
this year 🎉 Can’t wait to share my work and have lively discussions in London on 24-26 November!
#PCRPresenter
.
@PCRonline
#London
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Masterclass Presentation , elegant Dr.Fawaz and Dr.alshatti as usual !!!
#GulfPCR
,
@FBardooli
@DrAlshatti
and presence of Dr.Giulio Guagliumi , Intra coronary imaging Guru made it so rich and fruitful !! well done
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@AlkashkariWail
@mirvatalasnag
@drptca
@wagarhabib
@KFAFHCards
نشعر بالفخر ان نكون جزء من منظومة الرعاية الصحية للقلب في مملكتنا الحبيبه والخليج ونحن نتحرك بسرعه الضوء نحو القمه ، تمثيل سعودي مشرف من الدكتور خالد الشيبي
@drptca
و الدكتوره مرفت الاصنج
@mirvatalasnag
.. بوركتم وبوركت مساعيكم .. شي يثلج الصدر❤️🫀🫰 #همة_حتى_القمه ,
#GulfPCR
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55 year old male with intermittent chest pain for three weeks !!!
admitted as case of UA .. Echo shows EF 40% with hypokinesia of anterior wall !!
Post PCI
@DrNataliaP
@mmamas1973
@mirvatalasnag
@yeh_james3
@johaniMD
@tejsheth1
@bader1619
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@GEICC3
@EAPCIPresident
@agtruesdell
@AntoniousAttall
@HadyLichaaMD
@djc795
@AJuradoRoman
@mmamas1973
@SrihariNaiduMD
@hvanspall
@DKarmpaliotis
@Hragy
@evandrofilhobr
@gdodo92
if the patient is Mediterranean in origin, Behcet's syndrome could be one of the Differential Diagnoses !
Putting a stent in an inflamed vessel will not result of durable outcome !
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The
@Impella
dynamically increased coronary flow reserve and inversely decreased index of microcirculatory resistance up to 30 min after the initiation of cardiocirculatory support!!
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The case suggests favorable effects of the Impella on coronary microcirculation. LV unloading decreases LV end-diastolic pressure , and thus, would reduce endocardial pressure, which might result in a fall of microcirculatory resistance!!!
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points to remember :
1)Do not be afraid to stent to LM if there is no landing zone
2)Stop "I NAILED THE OSTIUM " practice!!!
3) If you tried to nail the ostium and failed , don't stop the DAPT
4) Stent failure needs IC imaging to assess the mode of failure !!
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@PCRonline
@AlkashkariWail
@wagarhabib
@ericalanosborn
@NielsRHolm
@gmcioffi
@AsherElad
@FBardooli
@Falmutairi2018
@FSQMD2
The IMR increased after rotational atherectomy from 19 to 31 , resulting in the deteriorated (CFR) despite the improved (FFR). One-month later, the IMR eventually recovered to 13 , suggesting that the influence of stent ablation on the coronary microcirculation was temporary!!!
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@ahmedknhi
@DrNataliaP
@mmamas1973
@mirvatalasnag
@yeh_james3
@johaniMD
@tejsheth1
@bader1619
in the settings of ACS and the presence of RWA to the anterior wall , i believe it was a recanalized thrombus ..
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@Falmutairi2018
@YouTube
اللسان والقلم ( والكيبورد ) يعجز عن وصف الفخر والافتخار بمجهوداتكم في التعليم المستمر والتنظيم الاحترافي للمؤتمرات ذات التخصص في المملكه والخليج العربي . بوركتم وبوركت مساعيكم
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@ChetRihal
PVL +LDH high + haptoglobin low + Hemoglobin low + indirect bilirubin high + and most importantly: the patient is sick !! needs some 3D images and to see suitability of plugging that thing up
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@CuissetDr
@mirvatalasnag
@PCRonline
@AlkashkariWail
@FBardooli
@DrAlsaiediAB
@MogneeA
@drmalahmari
@johaniMD
@KurdimohKurdi
@drptca
@wagarhabib
@DrShereen_
@chadialraies
@Sudanheartgroup
it has been truly a pleasure sir , phenomenal work and amazing organization.
chapeau bas 🤠!!
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Equipments:
#SuperCross
120° micro-catheter to cross the old stent struts to CTO LAD .when using the proper micro-catheter , anywire will go through , in my case
#Pilot50
wire did the job !!
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@AlkashkariWail
العباره الاخيره في التغريده جدا عميقه وتلمس كل المجالات .. " العلاقه بين البحث العلمي والجائحه علاقه طرديه "
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"From Desperation to Delisting" The Mitral Clip solution .
my full lecture was posted on YouTube by
@GisGulf
. Thank you very much GIS .
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@mirvatalasnag
@mmamas1973
@heartdoc45
@garand_f
@ShaneMarshallMD
@AnastasiaSMihai
@AtulPathak31
@SABOURETCardio
@DrMarthaGulati
@rladeiraslopes
@JGrapsa
@EdoardoMelilli
@hswapnil
@HecmagsMD
@ChristosArgyrop
@S_brimble
@venkmurthy
@majazayeri
@ash71us
@kidneydoc101
@krychtiukmd
@AliElzieny
@ShehabAnwer
@DocSavageTJU
@bcostelloMD
@thebyrdlab
@DrFerNunez
@HeartOTXHeartMD
@EkateriniL
@elenikle
@Maratosflier
@phila_lipidnp
@willsuh76
@SilCastelletti
@SGuptaMD
@ShrillaB
@CMichaelGibson
@DrJMieres
@lipiddoc
@HeartDocSharon
@drSujayShad
@SVRaoMD
@CaraCarahendry
@Pooh_Velagapudi
@gina_lundberg
Here is the thing , fundoscopy is important as any other part of physical exam to rule in/out Emergency cases from IM point of view ....
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@cardioPCImom
@mmamas1973
@jtsaxon
@djc795
@saraceciliamtz
@SVRaoMD
@ajaykirtane
@cardiojaydoc02
in FFR/IFR /RFR , severe aortic stenosis will act as a proximal stenosis to existing coronary stenoses and will alter the significance of physiology assessment results ... if no clear chest pain and moderate lesions ---> Fix the valve and assess symptoms as out patient !!
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@fjsawaya
@evandrofilhobr
@KambisMashayek1
@jedicath
@mirvatalasnag
@AlkashkariWail
@DrJMHill
Yes , been there , experienced that !!!
i bet you if you OCT that vessel you would find spiky calcified nodules!! .
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اشكر القائمين في الجمعية الخليجية لعلاج الصمامات بالقسطرة
@GisGulf
على عرض محاضرتي عن علاج الصمام الماترالي بالقسطره في صفحتهم على اليوتيوب .. تم اعاده نشر المحاضره في صفحتي لفائدة ذوي الاختصاص .شكرا لكم
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@mirvatalasnag
@GreggWStone
@cardiojaydoc02
@jedicath
@sbrugaletta
@hectortamezmd
@FelixValencia10
@saraceciliamtz
@mobitz
@moiz_hafiz
@drptca
@rwyeh
@CaraCarahendry
@JAG24851
@willsuh76
@mmamas1973
@DocSavageTJU
@Ortega_Paz
@CardiacConsult
@agtruesdell
@aspergian1
PLV will require at least 16 mm stent . I think first step Provisional and if PLV got pinched I will TAP ...
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@MBalghith
@Dr_I3rahimSaleh
@alhaydhal
@mohammedsa140
@sanggovsa
@KFSHRC
@modgovksa
@ACCinTouch
اولا : الف مبروك للشباب من شرفوا اوطانهم بهذا الانجاز العظيم .
ثانيا : ان هذا مثال من عديد من الأمثله المميزة لمخرجات التدريب السعودي بأياد سعودية بكفاءات عالمية
ثالثا:#السعودية_العظمى + #همة_حتى_القمه
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@mirvatalasnag
@EuroInterventio
@mmamas1973
@willsuh76
@sbrugaletta
@jedicath
@VijayKunadian
@Ortega_Paz
Stent LCX ...FFR LAD
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@AlkashkariWail
@evandrofilhobr
respectfully agreed with
@evandrofilhobr
about the risk of post dilatation in 95/5 % well anchored valve knowing that the valve will foreshorten from below !!
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@DrAliAlaraj
@TheSaudiHeart
@KFSHRC
@SACIS_SoMe
@SACIS_KSA
@KFSHRC_HE
@AbbottCardio
والله لك وحشه يا الحبيب... النور نورك يا بعدي
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@johaniMD
@DavidLBrownMD
@jedicath
@ajaykirtane
@mirvatalasnag
@mmamas1973
@AlkashkariWail
@Nabeelosis
@MBalghith
@DRKAMALAYOUB
MINOCA it is ... OCT that bad boy ... Between erosion VS plaque rupture .
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@Carlos_Cortes_V
@ramonlopezpalop
@PCRonline
@AlkashkariWail
@wagarhabib
@ericalanosborn
@NielsRHolm
@gmcioffi
@AsherElad
@FBardooli
@Falmutairi2018
@FSQMD2
very good point ,stay tuned for the next physiology case that i will post later in the day which will address that !!
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@AlkashkariWail
@GilbertTangMD
@mirvatalasnag
@Almanfi_Cardio
@GuiAttizzaniMD
@fjsawaya
@omendiz
@jwhansen1983
@didier_tchetche
@StevenYakubov
my humble opinion: he is 85 year old , he will not benefit much from a bigger orifice area and i have to accept mild to moderate PVL anyway because of the Heavy burden of calcification. 26 sounds very reasonable to me !!
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@HashimHayder
@AntoniousAttall
@RNarayanMD
@mmamas1973
@drandrewsharp
@ziadalinyc
@ShariqShamimMD
@Almanfi_Cardio
@jimijazz5
@ColleenMSM1
@KhandelwalMD
@Babar_Basir
Rotablation will definitely damage the two month old stent , IVL may do that too . The OCT image suggest that calcium is extending deep to the adventitia. And the shock wave will reach the calcium since that nodule is uncovered by the stent ...I am saying IVL and stent
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@johaniMD
an expert opinion. You are using to many tools with some size/shape mismatch .. i recommend IVUS guided cut of the cucumber and ANGIOJET the oranges into a jauce and microcatheter filling of the cream cheese into the sandwich ...Never ANGIOSEAL the bag .. PERCLOSE at 10 and 2
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@AlkashkariWail
I've done over 200 balloon expandable TAVRs .. i have Little knowledge of self expandable ones ..
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#Cardioquiz
EKG of 40 Y.O male with feeling of funny beats No cardiovascular illness before,what is it ? What to do
http://t.co/hirdloFT
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#Cardioquiz
Atrial fibrillation: management
ABCD:
Anti-coagulate
Beta-block to control rate
Cardiovert
Digoxin
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😨😨😨
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#Cardioquiz
In STEMI you need l:1mm elevation from isoelectrical ( after T wave and before P) line in limb leads and 2mm in chest leads
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@Falmutairi2018
@mohenews
@DoctorsWorld_
نفع الله بعلمكم وعملكم ودمتم رواد للرعاية الصحية بأعلى الكفاءات واحدث التقنيات . اعانكم الله وسدد خطاكم
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@Zayer_h
@DrAlshatti
@MogneeA
@dr_salehkhouj
@Dutra_1982
@MatthiasBossard
@Zeeshan_A2
@Drhassanmir
you are the culprit !!!
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@Zayer_h
@ProtectedPCI
@BotPci
@hamedsghamdi
@mirvatalasnag
@wagarhabib
@johaniMD
@HusamNoor1
@DrAlshatti
@almoghairi
@MogneeA
@NasserJAlhammad
1)< 60 year old should be referred for heart transplant .
2) i wish you took a longer cine to LIMA in order to study the ORCA vessel. how much collateral to RCA or LCX comes out from the LIMA .
3) clips !! , EF must be low and LV was dialated .
4) ICD , GDMT and PRAY !!!!
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@evandrofilhobr
@AlkashkariWail
@johaniMD
@DavidLBrownMD
@jedicath
@ajaykirtane
@mirvatalasnag
@mmamas1973
@Nabeelosis
@MBalghith
@DRKAMALAYOUB
Just start with RFR and your question will be answered without following small trials kind of evidence ...
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#Cardioquiz
55 year old old female with chest pain . What is it ? What to do
http://t.co/IkpSvEJ0
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@mirvatalasnag
@SCAI
@PCRonline
@sacisforum
@thiele_holger
@LAzzaliniMD
@RaberLorenz
@DocSavageTJU
@saraceciliamtz
@colum_owens
@keithachanmd
@evandrofilhobr
@ESHLOF
@Sticchi_Alex
@sbrugaletta
@inghaanMD
@BiascoDr
@Ortega_Paz
@poojaotherwise
@adityadoc1
@chadialraies
@KardiologieHH
@Hragy
@kaschenke
@icruzgonzalez
@RodrigoBagur
I would balloon , balloon and then a balloon followed by aggrestat infusion then re cath after two days .. my concern with the aspiration is not to bring a clot back to the OM or the LAD and then will be a nightmare for sure !!!
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@johaniMD
المشكله ان الاثنين في السياحيه ... طبعا الرد الأفضل في مثل هذه المواقف " يا رجال كلها توصل في نفس الوقت " وبعدين financial stable !!! الحمد لله الصيت ولا الغنى
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@DrJayMohan
@Almanfi_Cardio
@amrabbasmd
@AntoniousAttall
@timir_paul
@agtruesdell
@ekgpdx
@willsuh76
@yourheartdoc1
@adnanalkhouli
@sbrugaletta
@GreggWStone
@ShariqShamimMD
@MusaSharkawiMD
@djc795
@SVRaoMD
obviously the patient is old and never had any problem from his anomalous RCA . i do not believe this finding of any clinical significance if the LM is high enough. go for it !!!
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@AlkashkariWail
@mirvatalasnag
@drptca
@wagarhabib
@KFAFHCards
انت يا ابو ساره المايسترو ( الموسيقار ) لهذا المتثيل الوطني المشرف ولا يهونون الزملاء المشرفين والقائمين على جمعية أطباء القسطرة السعودية #السعودية_العظمى #همة_طويق
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#Cardioquiz
MI:sequence of elevated enzymes after MI
"C-AST-Le"(castle)
CK-MB first
AST second
LDH third
·Also: can use the last 'E'for ESR.
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@johaniMD
@mirvatalasnag
@Nabeelosis
@DRKAMALAYOUB
@MBalghith
@Dralkutshan
@wagarhabib
@AlkashkariWail
@KurdimohKurdi
Diarrhea sucks
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@AlkashkariWail
@TheSaudiHeart
@KFSHRC
@SACIS_SoMe
@SACIS_KSA
@KFSHRC_HE
@AbbottCardio
النور نورك يا زعيم
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@SACIS_KSA
@AlkashkariWail
@mirvatalasnag
@Falmutairi2018
@hamedsghamdi
@MosaAbbadi1
@DrOwayed
@DrReemhasan82
@assiri99
@DrNayef1
@DrAlsaiediAB
@MogneeA
@dr_nouf81
@chadialraies
@fjsawaya
@Hragy
جهد جبار ومبارك في وقت قياسي ومعايير عالمية . بوركتم وبورك مسعاكم وسدد خطاكم
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@FBardooli
underexpended stent at the ostium of LAD , malopposed stent at the LM . i did OCT, very cool pictures
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