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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