Case Submission Form: Mastering The Maze Symposium
Please fill out the form below to submit your complex interventional cardiology case. Ensure that all required fields are completed, and relevant documents are attached. The selected cases will be discussed during the symposium
Full Name
Phone Number
Email
Specialty
Institution/Hospital
Case Details
Case Title
Brief Case Description
Detailed Case Report
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Upload a comprehensive case report, including clinical history, diagnostic findings, and procedural details (PDF or Word format)
Diagnostic Images and Data
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Upload any relevant diagnostic images (e.g., angiograms, CT scans, etc.). Files accepted: JPG, PNG, DICOM, etc. (Up to 5 files).
Procedure Outcome
Key Challenges or Complications
Consent and Agreement
Patient Consent: By submitting this case, I confirm that all necessary patient consents have been obtained and that the case can be shared for educational purposes.
Agreement to Participate: agree to participate in a live discussion of the case if selected.
Submit your case for review
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