An athletic 63-year-old has a bioprosthetic aortic valve that is showing calcification and thickening. Can he safely proceed with his plans to climb Mount Kilimanjaro? A seemingly healthy 23-year-old presents to the ER with atypical chest pain and indications of aortic regurgitation. Is intervention needed immediately? An 86-year-old female with severe tricuspid regurgitation will not improve with medical therapy. What are her options?

These are a few of the cases discussed by 232 attendees at Baptist Health Miami Cardiac & Vascular Institute’s 41st annual Echocardiography and Structural Heart Symposium, held recently in Coral Gables. The group of cardiologists, cardiac surgeons, interventional cardiologists, sonographers and ultrasound technicians, critical care physicians, emergency medicine physicians and other specialists met to review the rapidly evolving guidelines, newest imaging technologies and latest procedures for valvular and structural heart issues.

“Forty-one years ago, the founders of this meeting recognized the importance of imaging and since that time many transformative technologies have saved millions of lives. We couldn’t have gotten there without imaging,” said Tom C. Nguyen, M.D., FACS, FACC, chief medical executive and Barry T. Katzen Endowed Chair of the Institute, where he is also the director of Minimally Invasive Valve Surgery. “At this meeting, we get knee-deep into the data and discuss the controversial issues that help us determine what’s best for our patients.”

Working in a field that can change the course of a patient’s life based on the classification of their cardiovascular condition as severe or moderate places multidisciplinary and shared decision-making at the forefront of patient care, explained Elliott Elias, M.D., medical director of Cardiac & Structural Imaging for the Institute and co-director of the symposium.

“It’s vital to look at this from a patient perspective and to get insight from the entire team,” Dr. Elias said. “As the technology continues to evolve, it’s important to understand the various techniques and the pitfalls. Reviewing particularly complex cases is very valuable.”

Among the Institute’s faculty presentations were:

Cardiologist Paula Montana De La Cadena, M.D., who presented “Ultrasound Unveiled: Exploring Aortic Regurgitation Assessment and Valvular Heart Disease Quantification from a Sonographer’s Perspective.” The young man who came to the ER with atypical chest pain had normal vital signs and a normal EKG. Further testing, including cardiac MRI, suggested aortic regurgitation but the patient did not meet today’s guidelines for surgery, although the parameters may be too conservative, Dr. Montana said. Additional testing, including repeated exercise stress testing, was debated. The patient is currently being monitored.

Cardiologist Eli Friedman, M.D., medical director of Sports Cardiology, who spoke on “Risk Stratification for Mount Kilimanjaro Ascents: A Guide for Decision-Making on Patient Eligibility.” His 63-year-old patient, who had a bioprosthetic aortic valve replacement nearly 15 years ago and bicycles 150-plus miles per week, hikes and participates in other strenuous sports, announced he was climbing Mount Kilimanjaro in two months. The valve was showing signs of calcification and thickening. “I cannot recreate an altitude of 19,000 feet, but we did cardiopulmonary exercise testing, where his VO2 was at 149 percent of what is predicted for a man of his age,” Dr. Friedman said. The patient also performed well on other tests, so Dr. Friedman developed an acclimation plan and prescribed medication to prevent high-altitude pulmonary edema. The man’s summit was a success.

Cardiac surgeon Ramon Quesada, M.D., director of Interventional & Structural Cardiac Innovations and director of Cardiac Research at the Institute, who presented “Tricuspid Clip in Focus: Managing TR Complexity Through Three Varied Cases.” One of the patients discussed by Dr. Quesada was an 86-year-old woman with severe tricuspid regurgitation who became the Institute’s first patient (and the first in Florida) to undergo the minimally invasive TriClip procedure. In clinical trials led by the Institute, the TriClip approach improved tricuspid regurgitation to moderate or less severity in 87 percent of patients.

The Institute’s multidisciplinary approach has been vital in helping patients, said Damian Chaupin, M.D., a cardiologist and co-director of the symposium. “This meeting pulls together a wide variety of disciplines because we have learned that a team-based approach is best,” he said. “The care of our patients can be quite complicated, and as the technology has progressed, we have been able, together, to develop new and better ways to treat and prevent cardiovascular problems. Our next steps are to further personalize care and to identify disease before there are symptoms.”

 “The discussions are very rich and varied and the case-based format is extremely helpful for learning purposes,” said Patrick O’Gara, M.D., Watkins Family Distinguished Chair in Cardiology
at Brigham and Women’s Hospital, professor of medicine at Harvard Medical School and faculty member of the symposium. “This is a course that presents the most advanced perspectives and helps the clinician become a better practitioner.”

The 42^nd Echocardiography and Structural Heart Symposium will be held Sept. 26-27, 2025, at the Loews Coral Gables Hotel.

To learn more and register, visit BaptistHealth.net/MiamiEcho.