Procedure Summary - Icahn School of Medicine at Mount Sinai



Procedure Summary

Name of Physician: ________________________________

Name of Institution: _______________________________

Total Months spent in Imaging for Structural Heart Interventions:

Served as a primary fellow on the following cases:

TAVR (TTE):

TAVR (TEE):

Transcatheter Mitral Valve Repair with Mitral Clip:

Transcatheter Mitral Valve Replacement:

PFO/ASD closure:

Balloon Aortic Valvuloplasty:

Balloon Mitral Valvuloplasty:

Alcohol Septal Ablation:

Aortic Paravalvular Leak Closure:

Mitral Paravalvular Leak Closure:

Valve in Valve (ViV) Aortic:

Valve in Valve (ViV) Mitral:

Tricuspid Valve Repair with a Clip:

Others:

Assisted as secondary fellow on the following cases:

____________________

____________________

____________________

____________________

Observed other cases:

____________________

____________________

____________________

____________________

NOTE: This Procedure Summary Log should be signed by the Director of Imaging for Structural Heart Interventions

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