Research Spotlight

Posted September 16th 2021

Summary: International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes.

William C. Roberts M.D.

William C. Roberts M.D.

Michelena, H. I., A. Della Corte, A. Evangelista, J. J. Maleszewski, W. D. Edwards, M. J. Roman, R. B. Devereux, B. Fernández, F. M. Asch, A. J. Barker, L. M. Sierra-Galan, L. De Kerchove, S. M. Fernandes, P. W. M. Fedak, E. Girdauskas, V. Delgado, S. Abbara, E. Lansac, S. K. Prakash, M. M. Bissell, B. A. Popescu, M. D. Hope, M. Sitges, V. H. Thourani, P. Pibarot, K. Chandrasekaran, P. Lancellotti, M. A. Borger, J. K. Forrest, J. Webb, D. M. Milewicz, R. Makkar, M. B. Leon, S. P. Sanders, M. Markl, V. A. Ferrari, W. C. Roberts, J. K. Song, P. Blanke, C. S. White, S. Siu, L. G. Svensson, A. C. Braverman, J. Bavaria, T. M. Sundt, G. El Khoury, R. De Paulis, M. Enriquez-Sarano, J. J. Bax, C. M. Otto and H. J. Schäfers (2021). “Summary: International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes.” Ann Thorac Surg 112(3): 1005-1022.

Full text of this article.

This International evidence-based nomenclature and classification consensus on the congenital bicuspid aortic valve and its aortopathy recognizes 3 types of bicuspid aortic valve: 1. Fused type, with 3 phenotypes: right-left cusp fusion, right-non cusp fusion and left-non cusp fusion; 2. 2-sinus type with 2 phenotypes: Latero-lateral and antero-posterior; and 3. Partial-fusion or forme fruste. This consensus recognizes 3 bicuspid-aortopathy types: 1. Ascending phenotype; root phenotype; and 3. extended phenotypes.


Posted September 16th 2021

International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes.

William C. Roberts M.D.

William C. Roberts M.D.

Michelena, H. I., A. D. Corte, A. Evangelista, J. J. Maleszewski, W. D. Edwards, M. J. Roman, R. B. Devereux, B. Fernández, F. M. Asch, A. J. Barker, L. M. Sierra-Galan, L. De Kerchove, S. M. Fernandes, P. W. M. Fedak, E. Girdauskas, V. Delgado, S. Abbara, E. Lansac, S. K. Prakash, M. M. Bissell, B. A. Popescu, M. D. Hope, M. Sitges, V. H. Thourani, P. Pibarot, K. Chandrasekaran, P. Lancellotti, M. A. Borger, J. K. Forrest, J. Webb, D. M. Milewicz, R. Makkaar, M. B. Leon, S. P. Sanders, M. Markl, V. A. Ferrari, W. C. Roberts, J. K. Song, P. Blanke, C. S. White, S. Siu, L. G. Svensson, A. C. Braverman, J. Bavaria, T. M. Sundt, G. El Khoury, R. De Paulis, M. Enriquez-Sarano, J. J. Bax, C. M. Otto and H. J. Schäfers (2021). “International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes.” Radiol Cardiothorac Imaging 3(4): e200496.

Full text of this article.

This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.


Posted September 16th 2021

Ventilation Monitoring.

Michael A.E. Ramsay M.D.

Michael A.E. Ramsay M.D.

Ramsay, M. (2021). “Ventilation Monitoring.” Anesthesiol Clin 39(3): 403-414.

Full text of this article.

Ventilation or breathing is vital for life yet is not well monitored in hospital or at home. Respiratory rate is a neglected vital sign and tidal volumes together with breath sounds are checked infrequently in many patients. Medications with the potential to depress ventilation are frequently administered, and may be accentuated by obesity causing airway obstruction in the form of sleep apnea. Sepsis may adversely affect ventilation by causing an increase in respiratory rate, often a very early sign of infection. Changes in ventilation may be early signs of deterioration in the patient.


Posted September 16th 2021

Is there a doctor on the plane? A review of in-flight emergencies for the on-board radiologist.

Sean D. Raj, M.D.

Sean D. Raj, M.D.

Vadhan, J. D., K. M. Raj and S. D. Raj (2021). “Is there a doctor on the plane? A review of in-flight emergencies for the on-board radiologist.” Clin Imaging 76: 265-273.

Full text of this article.

In-flight medical emergencies (IFME) are the acute on-service events involving illness or injury to a passenger with the potential for long-term health compromise. With the continuously rising number of flights available, both domestically and internationally, it is conceivable that the number of IFMEs will similarly continue to rise. Although most of these instances are relatively self-limited, the rare instance of a severe occurrence justifies preparation, both from in-flight staff and healthcare providers traveling on these flights. Given these events’ sporadic nature and the variable availability of medical support, all physicians need to understand their in-flight ethical and legal capabilities, the available medical supplies, and the most likely etiologies to manage such situations successfully. Most radiologists rarely utilize the hands-on, clinical skills developed in medical school or internship for emergencies beyond allergic contrast reactions. Therefore, they may not be adept in caring for patients during an IFME. As such, we present a thorough overview and literature review for the radiologist regarding the management of various acute IFMEs, with consideration for ethical and legal precedence and a review of medical equipment available on-board.


Posted September 16th 2021

Lumen-apposing metal stents (with videos).

Erik F. Rahimi, M.D.

Erik F. Rahimi, M.D.

Law, R. J., V. Chandrasekhara, A. Bhatt, J. C. Bucobo, A. P. Copland, K. Krishnan, N. A. Kumta, R. Pannala, M. A. Parsi, E. F. Rahimi, M. Saumoy, G. Trikudanathan, A. J. Trindade, J. Yang and D. R. Lichtenstein (2021). “Lumen-apposing metal stents (with videos).” Gastrointest Endosc 94(3): 457-470.

Full text of this article.

BACKGROUND AND AIMS: Lumen-apposing metal stents (LAMSs) are a novel class of devices that have expanded the spectrum of endoscopic GI interventions. LAMSs with their dumbbell configuration, short saddle length, and large inner luminal diameter provide favorable stent characteristics to facilitate anastomosis formation between the gut lumen and adjacent structures. METHODS: The MEDLINE database was searched through April 2021 for articles related to LAMSs by using additional relevant keywords such as “walled-off pancreatic necrosis,” “pseudocysts,” “pancreatic fluid collection,” “cholecystitis,” “gastroenterostomy,” in addition to “endoscopic treatment” and “endoscopic management,” among others. RESULTS: This technology review describes the full spectrum of LAMS designs and delivery systems, techniques for deployment, procedural outcomes, safety, training issues, and financial considerations. CONCLUSIONS: Although LAMSs were initially introduced for drainage of pancreatic pseudocysts and walled-off necrosis, the versatility of these devices has led to a variety of off-label uses including gallbladder drainage, enteric bypass with the creation of gastroenterostomies, and treatment of luminal GI strictures.