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“Heart Revolution” | Rob Malanuk | TEDxHammondSchool


good to be with you this afternoon I’m

good to be with you this afternoon I’m going to talk about the new

going to talk about the new

going to talk about the new revolutionary technologies in our field

revolutionary technologies in our field

revolutionary technologies in our field cardiology a quick review of the heart

cardiology a quick review of the heart

cardiology a quick review of the heart in 60 seconds we all be in our area

in 60 seconds we all be in our area

in 60 seconds we all be in our area cardiologists for that one of the

cardiologists for that one of the

cardiologists for that one of the disease states of pretty knowledgeable

disease states of pretty knowledgeable

disease states of pretty knowledgeable individuals Charles so if you have heart

individuals Charles so if you have heart

individuals Charles so if you have heart disease that’s cardiac related matter

disease that’s cardiac related matter

disease that’s cardiac related matter sweetheart they can be coronary or

sweetheart they can be coronary or

sweetheart they can be coronary or blockages in your heart you know

blockages in your heart you know

blockages in your heart you know electrical problems in your heart you

electrical problems in your heart you

electrical problems in your heart you have structural problems the muscle

have structural problems the muscle

have structural problems the muscle thing did that the balance inside part

thing did that the balance inside part

thing did that the balance inside part divides we’re going to produce some of

divides we’re going to produce some of

divides we’re going to produce some of those today whether I do advancement my

those today whether I do advancement my

those today whether I do advancement my highlight three that have come a really

highlight three that have come a really

highlight three that have come a really long to in the last year really some of

long to in the last year really some of

long to in the last year really some of the last couple months so if you are

the last couple months so if you are

the last couple months so if you are thinking about health care you can’t be

thinking about health care you can’t be

thinking about health care you can’t be not just a physician it takes a big team

not just a physician it takes a big team

not just a physician it takes a big team of people to be in the healthcare

of people to be in the healthcare

of people to be in the healthcare environment takes administrators with a

environment takes administrators with a

environment takes administrators with a staff technicians it takes providers

staff technicians it takes providers

staff technicians it takes providers like myself and you sucker got health

like myself and you sucker got health

like myself and you sucker got health care appealing to you wherever we’re men

care appealing to you wherever we’re men

care appealing to you wherever we’re men she said into that paradigm where there

she said into that paradigm where there

she said into that paradigm where there were plenty of opportunities to affect

were plenty of opportunities to affect

were plenty of opportunities to affect patients and in our health care I have

patients and in our health care I have

patients and in our health care I have large so for me the ton of money indeed

large so for me the ton of money indeed

large so for me the ton of money indeed was long for I was thirty years ago two

was long for I was thirty years ago two

was long for I was thirty years ago two years ago I was sitting at Hammond like

years ago I was sitting at Hammond like

years ago I was sitting at Hammond like new car today for years undergraduate

new car today for years undergraduate

new car today for years undergraduate school four years of medical school

school four years of medical school

school four years of medical school three years of residency four years of

three years of residency four years of

three years of residency four years of fellowship so after 12 years of hand

fellowship so after 12 years of hand

fellowship so after 12 years of hand I wasn’t quite halfway through the

I wasn’t quite halfway through the

I wasn’t quite halfway through the journey so says the moment you get

journey so says the moment you get

journey so says the moment you get sometimes four places but it is this is

sometimes four places but it is this is

sometimes four places but it is this is my career so this is your heart is four

my career so this is your heart is four

my career so this is your heart is four different chambers so you have two

different chambers so you have two

different chambers so you have two uppers and two bottles so it’s pretty

uppers and two bottles so it’s pretty

uppers and two bottles so it’s pretty simple right and left this is your left

simple right and left this is your left

simple right and left this is your left atrium this is your left ventricle right

atrium this is your left ventricle right

atrium this is your left ventricle right right atrium blood deoxygenated blood

right atrium blood deoxygenated blood

right atrium blood deoxygenated blood comes in through the right side of this

comes in through the right side of this

comes in through the right side of this out of the pulmonary valve for your to

out of the pulmonary valve for your to

out of the pulmonary valve for your to your lungs and is oxygen stuff comes

your lungs and is oxygen stuff comes

your lungs and is oxygen stuff comes your blood cells and then all force back

your blood cells and then all force back

your blood cells and then all force back into the left atrium and then shoots out

into the left atrium and then shoots out

into the left atrium and then shoots out the electrical in here aorta and out to

the electrical in here aorta and out to

the electrical in here aorta and out to your body that’s this your mark in 20

your body that’s this your mark in 20

your body that’s this your mark in 20 seconds the heart is surrounded by

seconds the heart is surrounded by

seconds the heart is surrounded by arteries that this is what I like to do

arteries that this is what I like to do

arteries that this is what I like to do I’m an interventional cardiologist the

I’m an interventional cardiologist the

I’m an interventional cardiologist the arteries are are your blood supply to

arteries are are your blood supply to

arteries are are your blood supply to your heart muscle so many times heart

your heart muscle so many times heart

your heart muscle so many times heart disease to be here somebody attacked is

disease to be here somebody attacked is

disease to be here somebody attacked is the biggest data cause heart disease is

the biggest data cause heart disease is

the biggest data cause heart disease is corner our disease and a blockage ER or

corner our disease and a blockage ER or

corner our disease and a blockage ER or develop a problem with the flow in one

develop a problem with the flow in one

develop a problem with the flow in one of these arteries but you could also

of these arteries but you could also

of these arteries but you could also have a bowel problem so you have four

have a bowel problem so you have four

have a bowel problem so you have four chambers you have four valves they also

chambers you have four valves they also

chambers you have four valves they also like the doors that let blood and in and

like the doors that let blood and in and

like the doors that let blood and in and out of your heart muscle so you have a

out of your heart muscle so you have a

out of your heart muscle so you have a mitral valve the tricuspid valve aortic

mitral valve the tricuspid valve aortic

mitral valve the tricuspid valve aortic valve and a whole lot of bowel again

valve and a whole lot of bowel again

valve and a whole lot of bowel again both allowing the directional blood flow

both allowing the directional blood flow

both allowing the directional blood flow line to your and out of your heart

line to your and out of your heart

line to your and out of your heart muscle so the EC is percutaneous

muscle so the EC is percutaneous

muscle so the EC is percutaneous coronary intervention that’s what

coronary intervention that’s what

coronary intervention that’s what routine basis has been quite a journey

routine basis has been quite a journey

routine basis has been quite a journey so back in the and the 80s rolled it off

so back in the and the 80s rolled it off

so back in the and the 80s rolled it off the screen but all we had was polka

the screen but all we had was polka

the screen but all we had was polka playing all the limbs of plastic so if

playing all the limbs of plastic so if

playing all the limbs of plastic so if you had a blockage in heart artery we

you had a blockage in heart artery we

you had a blockage in heart artery we put a balloon in it and pray play the

put a balloon in it and pray play the

put a balloon in it and pray play the balloon and pray that everything was

balloon and pray that everything was

balloon and pray that everything was gonna be okay when we deflating the

gonna be okay when we deflating the

gonna be okay when we deflating the balloon but oftentimes the artery this

balloon but oftentimes the artery this

balloon but oftentimes the artery this behavior claps right back on itself

behavior claps right back on itself

behavior claps right back on itself you put the bullying back out they were

you put the bullying back out they were

you put the bullying back out they were there for a while and then praying that

there for a while and then praying that

there for a while and then praying that when you deflated with everything will

when you deflated with everything will

when you deflated with everything will be okay but often the case was that

be okay but often the case was that

be okay but often the case was that people being sinner marginally down the

people being sinner marginally down the

people being sinner marginally down the hallway to have emergency bypass surgery

hallway to have emergency bypass surgery

hallway to have emergency bypass surgery because the RA just would not behave

because the RA just would not behave

because the RA just would not behave that way to stay over so we came along

that way to stay over so we came along

that way to stay over so we came along in the nineties the stencils from metal

in the nineties the stencils from metal

in the nineties the stencils from metal frames that helped scaffold already open

frames that helped scaffold already open

frames that helped scaffold already open so when you put the balloon inside of

so when you put the balloon inside of

so when you put the balloon inside of the stent inflate the balloon and the

the stent inflate the balloon and the

the stent inflate the balloon and the stick is expanded inside re and it

stick is expanded inside re and it

stick is expanded inside re and it already doesn’t can’t collapse again

already doesn’t can’t collapse again

already doesn’t can’t collapse again right so you put a piece of metal in

right so you put a piece of metal in

right so you put a piece of metal in well now we have second-generation

well now we have second-generation

well now we have second-generation instance so these are called

instance so these are called

instance so these are called drug-eluting so oftentimes the snip with

drug-eluting so oftentimes the snip with

drug-eluting so oftentimes the snip with sometimes insight trauma because we’re

sometimes insight trauma because we’re

sometimes insight trauma because we’re gonna inflate and traumatically inside

gonna inflate and traumatically inside

gonna inflate and traumatically inside the heart that already reacts to that

the heart that already reacts to that

the heart that already reacts to that trauma sometimes causes it every clock

trauma sometimes causes it every clock

trauma sometimes causes it every clock back up now these stents have drugs that

back up now these stents have drugs that

back up now these stents have drugs that on the outside of them it helps your

on the outside of them it helps your

on the outside of them it helps your body not have this

body not have this

body not have this adverse response and where we are today

adverse response and where we are today

adverse response and where we are today we’re in the newly released fully

we’re in the newly released fully

we’re in the newly released fully absorbable scaffold so it’s a system

absorbable scaffold so it’s a system

absorbable scaffold so it’s a system that actually is absorbed by your body

that actually is absorbed by your body

that actually is absorbed by your body over the course of time there’s quite a

over the course of time there’s quite a

over the course of time there’s quite a bit of pathways there’s about 10 years

bit of pathways there’s about 10 years

bit of pathways there’s about 10 years for it to evolve so if you put a spin in

for it to evolve so if you put a spin in

for it to evolve so if you put a spin in with why this is an artery we like a

with why this is an artery we like a

with why this is an artery we like a little skin to develop around the stance

little skin to develop around the stance

little skin to develop around the stance so that the stem took a camera inside

so that the stem took a camera inside

so that the stem took a camera inside the harder you wouldn’t even tell where

the harder you wouldn’t even tell where

the harder you wouldn’t even tell where the stent was there’s like a little skin

the stent was there’s like a little skin

the stent was there’s like a little skin cell layer that covers the stand

cell layer that covers the stand

cell layer that covers the stand sometimes that doesn’t always happen

sometimes that doesn’t always happen

sometimes that doesn’t always happen you may have a piece of the metal frame

you may have a piece of the metal frame

you may have a piece of the metal frame is never fully covered that can lead to

is never fully covered that can lead to

is never fully covered that can lead to late problems you can have plaque that

late problems you can have plaque that

late problems you can have plaque that develops Africa outside the skin and you

develops Africa outside the skin and you

develops Africa outside the skin and you can have what it was alluded to earlier

can have what it was alluded to earlier

can have what it was alluded to earlier is if the vessel just traumatically

is if the vessel just traumatically

is if the vessel just traumatically incites this growth inside the vessel in

incites this growth inside the vessel in

incites this growth inside the vessel in Harry’s done vessel back on and you can

Harry’s done vessel back on and you can

Harry’s done vessel back on and you can have maladies at abduction to the

have maladies at abduction to the

have maladies at abduction to the vessels that have traumas happened so

vessels that have traumas happened so

vessels that have traumas happened so these metal stents that we put in

these metal stents that we put in

these metal stents that we put in routinely are very good they help tons

routinely are very good they help tons

routinely are very good they help tons of thousands of people daily but

of thousands of people daily but

of thousands of people daily but sometimes they can lead to late term

sometimes they can lead to late term

sometimes they can lead to late term events so we’re always looking for it

events so we’re always looking for it

events so we’re always looking for it next cure and the stents have metal

next cure and the stents have metal

next cure and the stents have metal yours can have a permanent implant be

yours can have a permanent implant be

yours can have a permanent implant be there with your life forever necessarily

there with your life forever necessarily

there with your life forever necessarily want to have something there forever we

want to have something there forever we

want to have something there forever we can help it

can help it

can help it so in great artifact people don’t want a

so in great artifact people don’t want a

so in great artifact people don’t want a permanent implant you can’t get past it

permanent implant you can’t get past it

permanent implant you can’t get past it sometimes through little side branches

sometimes through little side branches

sometimes through little side branches that are there and so we’ve got some new

that are there and so we’ve got some new

that are there and so we’ve got some new data from this new absorbable stem that

data from this new absorbable stem that

data from this new absorbable stem that maybe over a course of time not having a

maybe over a course of time not having a

maybe over a course of time not having a current pathway this is five years out

current pathway this is five years out

current pathway this is five years out that kind of like toes as the skin and

that kind of like toes as the skin and

that kind of like toes as the skin and inside you is healed so this is the

inside you is healed so this is the

inside you is healed so this is the principal so if you’re an orthopedist

principal so if you’re an orthopedist

principal so if you’re an orthopedist secret screws and all that your bones

secret screws and all that your bones

secret screws and all that your bones are y’all some of you guys don’t have

are y’all some of you guys don’t have

are y’all some of you guys don’t have that happened to you so now these

that happened to you so now these

that happened to you so now these plastic screws that actually absorb and

plastic screws that actually absorb and

plastic screws that actually absorb and she we use suture material that absorbs

she we use suture material that absorbs

she we use suture material that absorbs and now we have spins that are

and now we have spins that are

and now we have spins that are absorbable this is made out of

absorbable this is made out of

absorbable this is made out of essentially starch just like cornstarch

essentially starch just like cornstarch

essentially starch just like cornstarch so it’s poly lactic acid that is kind of

so it’s poly lactic acid that is kind of

so it’s poly lactic acid that is kind of just like any other stent is the same

just like any other stent is the same

just like any other stent is the same model these little stem cells that allow

model these little stem cells that allow

model these little stem cells that allow us to expand artery so this is a ton of

us to expand artery so this is a ton of

us to expand artery so this is a ton of course we put a spin in it has a little

course we put a spin in it has a little

course we put a spin in it has a little healing process over three months and

healing process over three months and

healing process over three months and then three months to really none less

then three months to really none less

then three months to really none less the stiff starts to get absorbed by your

the stiff starts to get absorbed by your

the stiff starts to get absorbed by your body and then

body and then

body and then at two years is completely absorbed and

at two years is completely absorbed and

at two years is completely absorbed and replaced with a little the electrical

replaced with a little the electrical

replaced with a little the electrical structure the wall of your heart so

structure the wall of your heart so

structure the wall of your heart so pretty pretty pathways that this is what

pretty pretty pathways that this is what

pretty pretty pathways that this is what I stand inside party looks like so this

I stand inside party looks like so this

I stand inside party looks like so this is up

is up

is up you see these metal frames that are into

you see these metal frames that are into

you see these metal frames that are into this is a gentleman that had multiple

this is a gentleman that had multiple

this is a gentleman that had multiple students over ten years but this is what

students over ten years but this is what

students over ten years but this is what a horrible Scott Hall would look like

a horrible Scott Hall would look like

a horrible Scott Hall would look like Sing se margarita fix no residual that’s

Sing se margarita fix no residual that’s

Sing se margarita fix no residual that’s the principle so these days beginner are

the principle so these days beginner are

the principle so these days beginner are comfortable to what we have

comfortable to what we have

comfortable to what we have best-in-class with Zionist over this

best-in-class with Zionist over this

best-in-class with Zionist over this dead this is what a stent artery looks

dead this is what a stent artery looks

dead this is what a stent artery looks like so this will play right here

[Music]

[Music] vessels right here this is the gentleman

vessels right here this is the gentleman

vessels right here this is the gentleman with the back blockage right there you

with the back blockage right there you

with the back blockage right there you can see with the arteries block and then

can see with the arteries block and then

can see with the arteries block and then we do already the blockage right there

we do already the blockage right there

we do already the blockage right there this is moderating this is the hole in

this is moderating this is the hole in

this is moderating this is the hole in the balloon

the balloon

the balloon that’s it going in the vessel so where

that’s it going in the vessel so where

that’s it going in the vessel so where there was a blockage is no longer there

there was a blockage is no longer there

there was a blockage is no longer there and you don’t see the snip a metal frame

and you don’t see the snip a metal frame

and you don’t see the snip a metal frame that we typically see when we fix our

that we typically see when we fix our

that we typically see when we fix our T’s in coronary world so that’s the best

T’s in coronary world so that’s the best

T’s in coronary world so that’s the best stents and want us to technology 101 so

stents and want us to technology 101 so

stents and want us to technology 101 so the second part thing they’re wrong with

the second part thing they’re wrong with

the second part thing they’re wrong with your heart is paste is the electrical

your heart is paste is the electrical

your heart is paste is the electrical problem so we’re all sitting here today

problem so we’re all sitting here today

problem so we’re all sitting here today because our hearts are beating at a

because our hearts are beating at a

because our hearts are beating at a certain rate we all have these little

certain rate we all have these little

certain rate we all have these little cells calls times

cells calls times

cells calls times in our hearts it tells how fast and us

in our hearts it tells how fast and us

in our hearts it tells how fast and us little heartbeats you go so some people

little heartbeats you go so some people

little heartbeats you go so some people have an abnormality with that that we

have an abnormality with that that we

have an abnormality with that that we the pacemaker gets sick they end up

the pacemaker gets sick they end up

the pacemaker gets sick they end up needing a permanent pacemaker implanted

needing a permanent pacemaker implanted

needing a permanent pacemaker implanted to take over this work well this is an

to take over this work well this is an

to take over this work well this is an example of electrical phenomenon so this

example of electrical phenomenon so this

example of electrical phenomenon so this is a hardening beep and also you see no

is a hardening beep and also you see no

is a hardening beep and also you see no weakness asystole

weakness asystole

weakness asystole and in the heart it’s backed up again so

and in the heart it’s backed up again so

and in the heart it’s backed up again so that’s a gentleman who needs a permanent

that’s a gentleman who needs a permanent

that’s a gentleman who needs a permanent pacemaker put in

pacemaker put in

pacemaker put in I’ll take over that electrical need for

I’ll take over that electrical need for

I’ll take over that electrical need for the heart to do its work so this is the

the heart to do its work so this is the

the heart to do its work so this is the advent of pacemakers to this Dillman had

advent of pacemakers to this Dillman had

advent of pacemakers to this Dillman had a 1951 this is where we mark this may

a 1951 this is where we mark this may

a 1951 this is where we mark this may have to be plugged in and we are in the

have to be plugged in and we are in the

have to be plugged in and we are in the hospital

hospital

hospital permanently to stay alive and this is

permanently to stay alive and this is

permanently to stay alive and this is the machine that’s inaudible electrical

the machine that’s inaudible electrical

the machine that’s inaudible electrical signal to his heart they’re smarter by

signal to his heart they’re smarter by

signal to his heart they’re smarter by 1957 they had a size down to this little

1957 they had a size down to this little

1957 they had a size down to this little capacitor that would tell the heart and

capacitor that would tell the heart and

capacitor that would tell the heart and these wires would be inserted and again

these wires would be inserted and again

these wires would be inserted and again the lasts for like six months and have

the lasts for like six months and have

the lasts for like six months and have to be replaced we’ve come a long way and

to be replaced we’ve come a long way and

to be replaced we’ve come a long way and this is what’s typically put in so this

this is what’s typically put in so this

this is what’s typically put in so this is a pacemaker goes underneath the

is a pacemaker goes underneath the

is a pacemaker goes underneath the collar bone over here on your left side

collar bone over here on your left side

collar bone over here on your left side because the UMaine into your heart these

because the UMaine into your heart these

because the UMaine into your heart these little wires are position under x-ray to

little wires are position under x-ray to

little wires are position under x-ray to provide a signal a little electrical

provide a signal a little electrical

provide a signal a little electrical impulse for your heart to beat at a

impulse for your heart to beat at a

impulse for your heart to beat at a certain frequency or this is what it was

certain frequency or this is what it was

certain frequency or this is what it was like when an x-ray

like when an x-ray

like when an x-ray right here so now we come up with

right here so now we come up with

right here so now we come up with another generation by the time you guys

another generation by the time you guys

another generation by the time you guys go into biology or medicine this will be

go into biology or medicine this will be

go into biology or medicine this will be even smaller but this is the new micro

even smaller but this is the new micro

even smaller but this is the new micro pacemaker so this is the size of the

pacemaker so this is the size of the

pacemaker so this is the size of the bullet 22 caliber bullet that goes into

bullet 22 caliber bullet that goes into

bullet 22 caliber bullet that goes into the heart muscle to do that job

the heart muscle to do that job

the heart muscle to do that job solicited the victim paradigm this just

solicited the victim paradigm this just

solicited the victim paradigm this just got released within the last two months

got released within the last two months

got released within the last two months we did the first one our hospital in the

we did the first one our hospital in the

we did the first one our hospital in the state actually weeks ago so just an

state actually weeks ago so just an

state actually weeks ago so just an exciting time so this is a catheter so

exciting time so this is a catheter so

exciting time so this is a catheter so this is two that we put in your vein or

this is two that we put in your vein or

this is two that we put in your vein or as the tube up towards your right side

as the tube up towards your right side

as the tube up towards your right side of your heart it’s got the right

of your heart it’s got the right

of your heart it’s got the right ventricle and this thing is buried into

ventricle and this thing is buried into

ventricle and this thing is buried into the wall of the heart muscle and it’s

the wall of the heart muscle and it’s

the wall of the heart muscle and it’s got a little time on it that the

got a little time on it that the

got a little time on it that the catheter it drapes and stuff down into

catheter it drapes and stuff down into

catheter it drapes and stuff down into the heart and we press it into your

the heart and we press it into your

the heart and we press it into your heart muscle and then release it capsule

heart muscle and then release it capsule

heart muscle and then release it capsule form it’s got a little x that digging

form it’s got a little x that digging

form it’s got a little x that digging into the heart muscle gets trapped there

into the heart muscle gets trapped there

into the heart muscle gets trapped there and if we’re comfortable without well

and if we’re comfortable without well

and if we’re comfortable without well that devices been trapped inside then we

that devices been trapped inside then we

that devices been trapped inside then we cut little tethers a little dental floss

cut little tethers a little dental floss

cut little tethers a little dental floss is attached to it and we let it free and

is attached to it and we let it free and

is attached to it and we let it free and so this is so believed up here the

so this is so believed up here the

so this is so believed up here the permanent device this boat battery will

permanent device this boat battery will

permanent device this boat battery will last 12 years pretty incredible right so

last 12 years pretty incredible right so

last 12 years pretty incredible right so you mentioned your cell phone requires

you mentioned your cell phone requires

you mentioned your cell phone requires 24 hours and is dead this thing this

24 hours and is dead this thing this

24 hours and is dead this thing this little battery is inside the

little battery is inside the

little battery is inside the last for 12 years pretty incredible so

last for 12 years pretty incredible so

last for 12 years pretty incredible so our third topic today is restenosis so

our third topic today is restenosis so

our third topic today is restenosis so this is another big transformative

this is another big transformative

this is another big transformative therapy that we use in our patients each

therapy that we use in our patients each

therapy that we use in our patients each and every day and this is called aortic

and every day and this is called aortic

and every day and this is called aortic pray or Tadasana sisters this is the

pray or Tadasana sisters this is the

pray or Tadasana sisters this is the structural part your valid again on top

structural part your valid again on top

structural part your valid again on top of your heart fails to open this day or

of your heart fails to open this day or

of your heart fails to open this day or now as you might be born with this

now as you might be born with this

now as you might be born with this abnormal this is what Arnold

abnormal this is what Arnold

abnormal this is what Arnold Schwarzenegger had this is a rheumatic

Schwarzenegger had this is a rheumatic

Schwarzenegger had this is a rheumatic fever not usually a big problem in our

fever not usually a big problem in our

fever not usually a big problem in our country but in India this is still a big

country but in India this is still a big

country but in India this is still a big player and then obviously just seen

player and then obviously just seen

player and then obviously just seen anything older and your valve source

anything older and your valve source

anything older and your valve source engine to generate just like say an

engine to generate just like say an

engine to generate just like say an arthritic knee which to generate that

arthritic knee which to generate that

arthritic knee which to generate that the palate isn’t open as freely as it

the palate isn’t open as freely as it

the palate isn’t open as freely as it wants to and gets restricted so this

wants to and gets restricted so this

wants to and gets restricted so this disease is terrible once you have this

disease is terrible once you have this

disease is terrible once you have this almost if you have the aorta missus is

almost if you have the aorta missus is

almost if you have the aorta missus is like having a trouble in cancer so if

like having a trouble in cancer so if

like having a trouble in cancer so if your survival rate is 50% at one year

your survival rate is 50% at one year

your survival rate is 50% at one year without the new valve this is the

without the new valve this is the

without the new valve this is the terrible prognosis if you do acquire

terrible prognosis if you do acquire

terrible prognosis if you do acquire works pinnaces this is the whole way of

works pinnaces this is the whole way of

works pinnaces this is the whole way of fixing the mouse to the start surgeon

fixing the mouse to the start surgeon

fixing the mouse to the start surgeon would open up your chest of a correct

would open up your chest of a correct

would open up your chest of a correct day order we cut out the old valve and

day order we cut out the old valve and

day order we cut out the old valve and put a new one in

put a new one in

put a new one in survey to see all the sutures and you

survey to see all the sutures and you

survey to see all the sutures and you kind of glided in the place then you

kind of glided in the place then you

kind of glided in the place then you cinch it down investigator I ordered bow

cinch it down investigator I ordered bow

cinch it down investigator I ordered bow has been put in by this picture so what

has been put in by this picture so what

has been put in by this picture so what about another way so a lot of our

about another way so a lot of our

about another way so a lot of our patients will they need to a point in

patients will they need to a point in

patients will they need to a point in life where the too sick to go through

life where the too sick to go through

life where the too sick to go through the major heart surgery so we can fix

the major heart surgery so we can fix

the major heart surgery so we can fix the valve that is on the back end II

the valve that is on the back end II

the valve that is on the back end II wouldn’t survive the rigors of surgery

wouldn’t survive the rigors of surgery

wouldn’t survive the rigors of surgery because it’s a very rigorous process to

because it’s a very rigorous process to

because it’s a very rigorous process to go through so this is dr. Brenda who’s

go through so this is dr. Brenda who’s

go through so this is dr. Brenda who’s from Germany and he’s the he’s really

from Germany and he’s the he’s really

from Germany and he’s the he’s really the grandfather of interventional

the grandfather of interventional

the grandfather of interventional cardiology so he’s the first one who

cardiology so he’s the first one who

cardiology so he’s the first one who came up with a balloon angioplasty and

came up with a balloon angioplasty and

came up with a balloon angioplasty and he also thought about Nordic valves so

he also thought about Nordic valves so

he also thought about Nordic valves so this is the gentleman what we did the

this is the gentleman what we did the

this is the gentleman what we did the same thing for a ballet class he was

same thing for a ballet class he was

same thing for a ballet class he was what this is called and 1988 we did the

what this is called and 1988 we did the

what this is called and 1988 we did the first value last a pin

but anyway the story over God let’s put

but anyway the story over God let’s put a balloon inside and and then crank now

a balloon inside and and then crank now

a balloon inside and and then crank now though but unfortunately just like any

though but unfortunately just like any

though but unfortunately just like any other ordinary it will collapse back on

other ordinary it will collapse back on

other ordinary it will collapse back on itself

itself

itself so we’ve come up with a stent mouth this

so we’ve come up with a stent mouth this

so we’ve come up with a stent mouth this is called hammer this is you pry her

is called hammer this is you pry her

is called hammer this is you pry her this may be known in the leg press but

this may be known in the leg press but

this may be known in the leg press but this is a valve is sewn inside this

this is a valve is sewn inside this

this is a valve is sewn inside this whole stem frame that is deployed across

whole stem frame that is deployed across

whole stem frame that is deployed across the heart muscle across the earth valve

the heart muscle across the earth valve

the heart muscle across the earth valve it was playing so this is the secret now

it was playing so this is the secret now

it was playing so this is the secret now 15 years out this is the first one done

15 years out this is the first one done

15 years out this is the first one done in 2002 you can see how scared these

in 2002 you can see how scared these

in 2002 you can see how scared these guys look but this is the this is the

guys look but this is the this is the

guys look but this is the this is the back this valve is one of a stent being

back this valve is one of a stent being

back this valve is one of a stent being expanded inside this artery so this is

expanded inside this artery so this is

expanded inside this artery so this is how we do these procedures so this is

how we do these procedures so this is

how we do these procedures so this is all done through a catheter protectors

all done through a catheter protectors

all done through a catheter protectors achieved under deliver American trigger

achieved under deliver American trigger

achieved under deliver American trigger so this guy is done from your firm Ord

so this guy is done from your firm Ord

so this guy is done from your firm Ord aorta and is gonna retroflex back bears

aorta and is gonna retroflex back bears

aorta and is gonna retroflex back bears them to stick balance we’ve put a wire

them to stick balance we’ve put a wire

them to stick balance we’ve put a wire past the aortic valve as your hearts

past the aortic valve as your hearts

past the aortic valve as your hearts beating and this is machine it’s a large

beating and this is machine it’s a large

beating and this is machine it’s a large sheet and that’s what’s really happening

sheet and that’s what’s really happening

sheet and that’s what’s really happening the last five years the machine has gone

the last five years the machine has gone

the last five years the machine has gone from something the size of your thumb to

from something the size of your thumb to

from something the size of your thumb to something about the size of a pen like a

something about the size of a pen like a

something about the size of a pen like a writer writing that this is the value

writer writing that this is the value

writer writing that this is the value sorry as we put it across the bow this

sorry as we put it across the bow this

sorry as we put it across the bow this is the balloon we expand a balloon

is the balloon we expand a balloon

is the balloon we expand a balloon deflate the balloon that balloon comes

deflate the balloon that balloon comes

deflate the balloon that balloon comes out

out

out a little bit more compliant a little bit

a little bit more compliant a little bit

a little bit more compliant a little bit more flexible and now we’re putting in

more flexible and now we’re putting in

more flexible and now we’re putting in the transcatheter valve there comes we

the transcatheter valve there comes we

the transcatheter valve there comes we just have to position it correctly

just have to position it correctly

just have to position it correctly inside the tube going inside the stent

inside the tube going inside the stent

inside the tube going inside the stent Frank sit down

Frank sit down

Frank sit down across the stick down here since

across the stick down here since

across the stick down here since expanded the balloon comes out the new

expanded the balloon comes out the new

expanded the balloon comes out the new valve is working in place and everything

valve is working in place and everything

valve is working in place and everything is now we’re gonna buy a new palace in

is now we’re gonna buy a new palace in

is now we’re gonna buy a new palace in order so that relieves the burden for

order so that relieves the burden for

order so that relieves the burden for the nation and half the way

the nation and half the way

the nation and half the way so this is a picture of schematic

so this is a picture of schematic

so this is a picture of schematic exactly what it looks like on your

exactly what it looks like on your

exactly what it looks like on your x-rays what we see when we’ll see that’s

x-rays what we see when we’ll see that’s

x-rays what we see when we’ll see that’s pretty greedy so that’s that’s a quick

pretty greedy so that’s that’s a quick

pretty greedy so that’s that’s a quick review of cardiology I think that you

review of cardiology I think that you

review of cardiology I think that you know I feel is exciting I love the

know I feel is exciting I love the

know I feel is exciting I love the technology of a physiology of hard work

”

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