Dr Dharam P Saran

Small town Interventional Cardiologist, Strongly believe in affordable healthcare to all, Father of two, Happy to go

[Dr Dharam P Saran @DharamPSaran]

@PurumittalDr LCx for sure, RCA can be attempted in minimal contrast possible, if looks like a long journey better avoided in acute phase.

[Dr Dharam P Saran @DharamPSaran]

@Nasser_Ghattar With wire in place it can’t embolize anywhere, practically not possible to leave the wire rail. Only chance is that it’s lost on the way to coronary, that path is guide catheter only.

[Dr Dharam P Saran @DharamPSaran]

@nadig_cardio Basic teaching says stay away from ectatic segment, if there is no healthy landing zone let 1-2 strut hang in ectasia, like we do in Ostial lesions.
I don’t know why you tried to cover ectatic segment, you won’t be able to appose no matter how much you expand your stent,

[Dr Dharam P Saran @DharamPSaran]

@Drakhil_cardio @DrRajeshG1 @iamritu @ESC_Journals @CardioNerds @CadioArena @ACCinTouch @MDedgeCardio @SinaiCards @UCSDCardFellows @BrJCardiol I won’t dare to inject in this situation.

[Dr Dharam P Saran @DharamPSaran]

@DrIHHashmi1 Dilated a bridge, there was no lesion to start with.

[Dr Dharam P Saran @DharamPSaran]

@PurumittalDr Considering slow flow and thrombus everywhere I will stay provisional as long as there is TIMI3 in side vessel.
Residual disease (even bifurcation) can be addressed in stage setting when fire is settled .

[Dr Dharam P Saran @DharamPSaran]

@ActusDei Personal Finance

[Dr Dharam P Saran @DharamPSaran]

@Drakhil_cardio @iamritu @DrRajeshG1 @ESC_Journals @MDedgeCardio @CardiologyNGHA @SinaiCards @DukeCardFellows @DAICeditor @AmJCardio @CardioNerds PVL closure? Quite a innovation👏👏

[Dr Dharam P Saran @DharamPSaran]

@nadig_cardio Thanks for sharing

[Dr Dharam P Saran @DharamPSaran]

@Hragy Hyperaldosteronism likely.
This might be an acquired HCM of hypertensive elderly.

[Dr Dharam P Saran @DharamPSaran]

@nadig_cardio Certainly not for a young patient. While Councelling a patient about multivessel PTCA a sane cardiologist certainly thinks whether a CABG will be a better option. But when targets are not good or arteries can’t be offered do surgeons think another way I am not sure😔

[Dr Dharam P Saran @DharamPSaran]

@nadig_cardio Mycotic unless proved otherwise. Elderly may have minimal or no inflammatory response to infection. Drug allergy may be the next closest. Very high CRP and Small Pericardial effusion are consistently associated with mycotic aneurysm. Like in IE counts are very often normal.

[Dr Dharam P Saran @DharamPSaran]

@nadig_cardio @abadkhan2002 @JoySanyal74 @drkk4u @ESC_Journals @serioustaurean @latambifclub @BifurcationClub @AmBifClub This is Step crush actually, advantage over mini crush is that it’s feasible with 6F guide, unlike mini crush where you carry two stent together and 7F is a must.

[Dr Dharam P Saran @DharamPSaran]

@DrIHHashmi1 LM to LAD with Synergy Megatron

[Dr Dharam P Saran @DharamPSaran]

@nadig_cardio @JoySanyal74 @abadkhan2002 Predilate LMCA, Guide extension across the first LCx bend, CB and high P NC dilation of LCx-OM, try to stay provisional as carrying 2 devices across bend appears very difficult. End with LM to LCx stent.

[Dr Dharam P Saran @DharamPSaran]

@nadig_cardio Unless there is a true ostial RCA lesion, starting the case with AL 1 or may be .75!for smaller aortic roots will mostly take away the pain of balloon or micro uncross situation, IMHO

[Dr Dharam P Saran @DharamPSaran]

@Drakhil_cardio @TrackYourHeart @MDedgeCardio @CardioNerds @escardio @radcliffeCARDIO @CardiologyNGHA @fellow_cardio @MGH_IC_Research @DrRajeshG1 @PreMedTweets PVL closure👏👏

[Dr Dharam P Saran @DharamPSaran]

@Bajaj_Finserv Fastag service is pathetic. Despite wallet balance of more then 2000, at every toll plaza it shows insufficient balance. Had to pay more then 1200 INR for a round trip across 3 tolls. As usual customer care service is even disastrous, no cc executive is free.

[Dr Dharam P Saran @DharamPSaran]

@GopalKkoduru IMHO- AL guide for good support, workhorse wire with micro, exchange with extra support wire like Grandslam, if not enough to deliver the tools to the lesion, add guidezilla now.
Trio of AL guide, Grandslam wire and Guidezilla, almost never disappoint.

[Dr Dharam P Saran @DharamPSaran]

@nadig_cardio So well though and executed Sir🙏. I always have so many queries in mind while going through such cases.
Like in this case,
1. How about the rhythm at discharge. If CHB reverts to SR with BFB, would you consider AICD or pacing?
2.What if this patient comes on day 3? Same way?