Arnav Kumar, MD, MSCR

Houston IC & Structural | Alum @BrighamWomens @harvardmed | Via @emory_heart @EmoryCCRI | #ShearStress #ComputationalImaging 🇮🇳Cricket

[Arnav Kumar, MD, MSCR @arnavkumar]

@realarainmd Agreed — clearly I need to level up my #HDR-Twitter skills from you, @realarainmd. 😂 I tried improving the image quality, but Twitter keeps humbling me by reverting it to potato mode every time I post. 🥔📸. Thank you for all your coaching @realarainmd!

[Arnav Kumar, MD, MSCR @arnavkumar]

When the #CTO cap says no, & the side branch says yes: fighting wire bias on an angulated, calcified occlusion.

Prior CABG, refractory #angina, PET showing reversible #ischemia in the RCA territory.

One case, multiple techniques — learnt from mentors, colleagues, and friends.

#CTO #CTOPCI #CABG #ADR #HDR #Atherectomy
#CardioTwitter #MedED #MedTwitter

@Murmur_MD @DLBHATTMD @HadyLichaaMD @YChatzizisis @iamritu @CASivaram1 @purviparwani @Pooh_Velagapudi

[Arnav Kumar, MD, MSCR @arnavkumar]

#CTOPCI — Pt Late 80s, refractory angina + reversible #ischemia on PET
Fielder XT crosses the lesion — microcatheter & balloons won't follow.
→ 0.9 Excimer Laser — limited crossing, but penetrated the cap.
→ #HDR confirms true lumen — Minamo can't advance.
→ Re-wire with Fielder — Takeru crosses.
→ Re-laser #atherectomy → Serial predilations — Shockwave over Minamo → #IVUS guided Stents ✅
#CardioTwitter #InterventionalCardiology #MedTwitter
#CardioEd

[Arnav Kumar, MD, MSCR @arnavkumar]

Escalated to #Impella 5.5.
Staged #PCI — LAD-Diag bifurcation: crossed LAD→diag with Fielder, Rota, re-crossed into true LAD.
Days later: LCX-OM PCI.
Impella 5.5 enabled early ambulation → weaned off. Discharged home. Rpt echo @ 3 months pending. #CardioTwitter @DLBHATTMD #CHIP

[Arnav Kumar, MD, MSCR @arnavkumar]

Here is the angiogram sent to us.
@realarainmd @AlpeshShahMD @AllaqabanSuhail
@MichaelMegalyMD @DocSavageTJU @mmamas1973
@HeartOTXHeartMD @Pooh_Velagapudi @iamritu
#CardioTwitter #CHIP #HighRiskPCI #MedTwitter

[Arnav Kumar, MD, MSCR @arnavkumar]

@realarainmd @AlpeshShahMD @AllaqabanSuhail @MichaelMegalyMD @DocSavageTJU @mmamas1973 @HeartOTXHeartMD @Pooh_Velagapudi @iamritu Trp 1100 >> Diuresis + heparin. Reached day 5 >>
RHC: PCWP 30, CO 3.2, CI 1.6, SVR 1800 >> milrinone + Bumex.
Sx concern: high risk of failure to wean from bypass + preference to preserve an 'unoperated chest' given possible future transplant. Day 9 echo (on milrinone). Nxt?

[Arnav Kumar, MD, MSCR @arnavkumar]

Pt: late 50s, previously active, one wk SOB.
LVEF 15%.Transferred for high-risk PCI.
On arrival, CMR viable LCX and diagonal, but transmural scar distal LAD—small apical LV Thrombus.
>> Turned down for CABG.
Angiogram from referring attached below.
What would you do?

[Arnav Kumar, MD, MSCR @arnavkumar]

Here is the angiogram sent to us.
@realarainmd @AlpeshShahMD @AllaqabanSuhail
@MichaelMegalyMD @DocSavageTJU @mmamas1973
@HeartOTXHeartMD @Pooh_Velagapudi @iamritu
#CardioTwitter #CHIP #HighRiskPCI #MedTwitter

[Arnav Kumar, MD, MSCR @arnavkumar]

@paragbawaskar Excellent question - Transmural Scar in the RCA territory.

[CICUdevices @CicUdevices]

• IMPELLA OFF-LABEL USE: ECMELLA.

It is one of the most common off-label uses of Impella CP.

Although not FDA-approved, LV unloading during VA-ECMO has become common practice in experienced shock centers, particularly when left ventricular distension is detected. #impella

[Arnav Kumar, MD, MSCR @arnavkumar]

@realarainmd @grok @girishviswa Wow we might have to cath lab consult @grok when @realarainmd is out of the country lol - I have had good success with 50:50 laser on contrast approach when even microcatheters won’t spin across the lesion. I always use a trap to make sure push out blood when using laser.

[Arnav Kumar, MD, MSCR @arnavkumar]

@AllaqabanSuhail @AbbottCardio @ACCinTouch @HCAHouston @DLBHATTMD @YChatzizisis @AortaSurg @docbhardwaj @heartdoc45 @khaledchatila1 @khurramn1 @RAQuintMD @SalimaqMD @realarainmd @AlpeshShahMD Thank you @AllaqabanSuhail — that means a great deal coming from you. Exactly right — when the anatomy cooperates and the team is aligned, these outcomes remind us why we do this work. Grateful for your kind words.

[Arnav Kumar, MD, MSCR @arnavkumar]

#MitraClip — device time <15 min — structural MR, no surgical options. Patient woke up feeling 100% better.
This is why structural heart intervention matters.
@AbbottCardio @ACCinTouch @HCAHouston @DLBHATTMD #TEER #StructuralHeart #InterventionalCardiology

[Salman Arain @realarainmd]

What’s YOUR next move?!

@Grok may well be the wisest #CTOPCI guru to have never set a foot in the cath lab! 😂

A great f/u question. My 1st move is almost always to build up support. This is by far the most common reason devices won’t cross.

Option #2 is modify the cap/plaque.

[Arnav Kumar, MD, MSCR @arnavkumar]

@ShariqShamimMD @AbbottCardio @ACCinTouch @HCAHouston @DLBHATTMD @YChatzizisis @AortaSurg @docbhardwaj @heartdoc45 @khaledchatila1 @khurramn1 @RAQuintMD @SalimaqMD @realarainmd @AlpeshShahMD Fair point, @ShariqShamimMD. For every 15-min elective clip posted online, there's a 3-hour functional MR TEER in shock on Impella 5.5. Valuation should reflect the full episode of care — planning, imaging, hemodynamics, follow-up — not the fastest anecdote

[Arnav Kumar, MD, MSCR @arnavkumar]

@realarainmd @AbbottCardio @ACCinTouch @HCAHouston @DLBHATTMD @YChatzizisis @AortaSurg @docbhardwaj @heartdoc45 @khaledchatila1 @khurramn1 @RAQuintMD @SalimaqMD @AlpeshShahMD Thank you, @realarainmd! That's a fair point. Outcomes with #TEER for degenerative MR tend to be more predictable, while functional MR results are more dependent on patient selection.

[Arnav Kumar, MD, MSCR @arnavkumar]

@realarainmd @habib_samady @AllanLKleinMD1 @SachinGoelMD @iamritu @SaadGhummanMD @PedroMDMSc @CASivaram1 @fangjonathanx @DrLouMDPhD Once the wire was confirmed true luminal, we still couldn’t cross with a microcatheter or 1.0/1.25 balloons. Used 50:50 laser on contrast to cross, and the lesion then yielded nicely with scoring balloons. Any tips on alternative approaches? @realarainmd @DLBHATTMD

[Arnav Kumar, MD, MSCR @arnavkumar]

@realarainmd @habib_samady @AllanLKleinMD1 @SachinGoelMD @iamritu @SaadGhummanMD @PedroMDMSc @CASivaram1 @fangjonathanx @DrLouMDPhD Thank you, @realarainmd! We also felt this was likely a calcified nodule. Once crossed with a Fielder XT, we probed distal side branches to confirm true lumen position. Subtotal lesions, absent guiding collaterals, and elevated EDP in severe #AS can make these cases challenging.

[Arnav Kumar, MD, MSCR @arnavkumar]

Is even mild PVL no longer acceptable in #TAVR?
Our editorial on the #OCEAN-TAVI trial is now published in JACC: Interventions.

https://t.co/SFiZArziLp

[Salman Arain @realarainmd]

RTIG Cap Puncture Tutorial

Here is a ‘self learning’ real time IVUS guided cap puncture tutorial as requested by several colleagues.

It has two parts - one for the angio and another for the IVUS. The primary operator usu. goes back and forth bet. them in real time.

Questions, comments and suggestions welcome!🙏🏼