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Article ; Online: Misidentification of the True Aortic Annulus With 2-dimensional Echocardiography: A Critical Appraisal Using 3-Dimensional Imaging.

Sharkey, Aidan / Khan, Adnan A / Yunus, Rayaan / Rehman, Taha / Bu, Yifan / Saeed, Shirin / Matyal, Robina / Mahmood, Feroze

Journal of cardiothoracic and vascular anesthesia

2024

Abstract: Objectives: This study aimed to evaluate the accuracy of identifying the true aortic valve (AV) annulus using 2-dimensional (2D) echocardiography, with the goal of highlighting potential misidentification issues in clinical practice.: Design: An ... ...

Abstract	Objectives: This study aimed to evaluate the accuracy of identifying the true aortic valve (AV) annulus using 2-dimensional (2D) echocardiography, with the goal of highlighting potential misidentification issues in clinical practice. Design: An observational study employing 3-dimensional (3D) datasets to generate 2D images of the AV annulus for analysis. Setting: The study was conducted in an academic medical center. Participants: Three-dimensional transesophageal echocardiography datasets were obtained from 11 patients with normal AV and aortic root anatomies undergoing coronary artery bypass surgery. Attending anesthesiologists certified by the National Board of Echocardiography (NBE) were approached subsequently to participate in this study. Interventions: Two images per patient were generated from 3D datasets, reflecting the mid-esophageal long-axis view of the AV, a true AV annulus image, and an off-axis image. A survey was distributed to NBE-certified perioperative echocardiographers across 12 academic institutions to identify the true AV annulus from these images. Measurements and main results: The survey, completed by 45 qualified respondents, revealed a significant misidentification rate of the true AV annulus, with only 36.8% of responses correctly identifying it. The rate of correct identification varied across image sets, with 44.4% of participants unable to correctly identify any true AV annulus image. Conclusions: The study highlighted the limitations of 2D echocardiography in accurately identifying the true AV annulus in complex 3D structures like the aortic root. The findings suggest a need for greater reliance on advanced imaging modalities, such as 3D echocardiography, to improve accuracy in clinical practice.
Language	English
Publishing date	2024-03-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2024.03.004
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Article ; Online: Structural and Electrical Integrity of Transesophageal Echocardiography Probes: Importance and Key Concepts.

Rehman, Taha A / Khan, Adnan Ali / Yunus, Rayaan Ahmed / Bu, Yifan / Sohail, Ahmed / Matyal, Robina / Mahmood, Feroze / Sharkey, Aidan

Journal of cardiothoracic and vascular anesthesia

2023 Volume 37, Issue 7, Page(s) 1088–1094

Abstract: The clinical utility of transesophageal echocardiography (TEE) is well-established for patients undergoing cardiac surgery. With the increase in percutaneous structural heart disease procedures that rely on TEE for procedural guidance, the use of TEE ... ...

Abstract	The clinical utility of transesophageal echocardiography (TEE) is well-established for patients undergoing cardiac surgery. With the increase in percutaneous structural heart disease procedures that rely on TEE for procedural guidance, the use of TEE probes is expanding. Although there are well-established protocols for routine cleaning and decontaminating TEE probes between patient use, there is a lack of awareness and misconceptions about maintaining TEE probes' structural and electrical integrity. The electrical leakage test (ELT) is routinely performed between patient use. From a patient safety standpoint, the ELT is necessary to ensure the longevity of this expensive equipment and prevent disruptions to the workflow in a busy department caused by TEE probes being decommissioned due to probe damage. This technical communication aims to highlight the importance of maintaining TEE probes' structural and electrical integrity. The article also highlights and discusses probe handling techniques between patient use, emphasizing the ELT to ensure patient safety and compliance with national and international standards.
MeSH term(s)	Humans ; Echocardiography, Transesophageal/methods ; Cardiac Surgical Procedures
Language	English
Publishing date	2023-03-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.03.015
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Article ; Online: Virtual Reality: The Future of Invasive Procedure Training?

Savir, Shiri / Khan, Adnan A / Yunus, Rayaan A / Rehman, Taha A / Saeed, Shirin / Sohail, Mahnoor / Sharkey, Aidan / Mitchell, John / Matyal, Robina

Journal of cardiothoracic and vascular anesthesia

2023 Volume 37, Issue 10, Page(s) 2090–2097

Abstract: Invasive procedures are associated with adverse events that are both hazardous to patients and expensive to treat. A trainee is expected to perform complex sterile invasive procedures in a dynamic environment under time pressure while maintaining patient ...

Abstract	Invasive procedures are associated with adverse events that are both hazardous to patients and expensive to treat. A trainee is expected to perform complex sterile invasive procedures in a dynamic environment under time pressure while maintaining patient safety at the highest standard of care. For mastery in performing an invasive procedure, the automatism of the technical aspects is required, as well as the ability to adapt to patient conditions, anatomic variability, and environmental stressors. Virtual reality (VR) simulation training is an immersive technology with immense potential for medical training, potentially enhancing clinical proficiency and improving patient safety. Virtual reality can project near-realistic environments onto a head-mounted display, allowing users to simulate and interact with various scenarios. Virtual reality has been used extensively for task training in various healthcare-related disciplines and other fields, such as the military. These scenarios often incorporate haptic feedback for the simulation of physical touch and audio and visual stimuli. In this manuscript, the authors have presented a historical review, the current status, and the potential application of VR simulation training for invasive procedures. They specifically explore a VR training module for central venous access as a prototype for invasive procedure training to describe the advantages and limitations of this evolving technology.
MeSH term(s)	Humans ; Virtual Reality ; Computer Simulation ; Simulation Training/methods
Language	English
Publishing date	2023-06-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.06.032
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Article ; Online: Artificial Intelligence for Anesthesiology Board-Style Examination Questions: Role of Large Language Models.

Khan, Adnan A / Yunus, Rayaan / Sohail, Mahad / Rehman, Taha A / Saeed, Shirin / Bu, Yifan / Jackson, Cullen D / Sharkey, Aidan / Mahmood, Feroze / Matyal, Robina

Journal of cardiothoracic and vascular anesthesia

2024 Volume 38, Issue 5, Page(s) 1251–1259

Abstract: New artificial intelligence tools have been developed that have implications for medical usage. Large language models (LLMs), such as the widely used ChatGPT developed by OpenAI, have not been explored in the context of anesthesiology education. ... ...

Abstract	New artificial intelligence tools have been developed that have implications for medical usage. Large language models (LLMs), such as the widely used ChatGPT developed by OpenAI, have not been explored in the context of anesthesiology education. Understanding the reliability of various publicly available LLMs for medical specialties could offer insight into their understanding of the physiology, pharmacology, and practical applications of anesthesiology. An exploratory prospective review was conducted using 3 commercially available LLMs--OpenAI's ChatGPT GPT-3.5 version (GPT-3.5), OpenAI's ChatGPT GPT-4 (GPT-4), and Google's Bard--on questions from a widely used anesthesia board examination review book. Of the 884 eligible questions, the overall correct answer rates were 47.9% for GPT-3.5, 69.4% for GPT-4, and 45.2% for Bard. GPT-4 exhibited significantly higher performance than both GPT-3.5 and Bard (p = 0.001 and p < 0.001, respectively). None of the LLMs met the criteria required to secure American Board of Anesthesiology certification, according to the 70% passing score approximation. GPT-4 significantly outperformed GPT-3.5 and Bard in terms of overall performance, but lacked consistency in providing explanations that aligned with scientific and medical consensus. Although GPT-4 shows promise, current LLMs are not sufficiently advanced to answer anesthesiology board examination questions with passing success. Further iterations and domain-specific training may enhance their utility in medical education.
MeSH term(s)	Humans ; Anesthesiology ; Artificial Intelligence ; Prospective Studies ; Reproducibility of Results ; Language
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2024.01.032
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Article ; Online: A systematic review and meta-analysis of general versus regional anesthesia for lower extremity amputation.

Mufarrih, Syed H / Qureshi, Nada Q / Yunus, Rayaan A / Katsiampoura, Anastasia / Quraishi, Ibrahim / Sharkey, Aidan / Mahmood, Feroze / Matyal, Robina

Journal of vascular surgery

2022 Volume 77, Issue 5, Page(s) 1542–1552.e9

Abstract: Objective: Postoperative morbidity in patients undergoing lower extremity amputation (LEA) has remained high. Studies investigating the influence of the anesthetic modality on the postoperative outcomes have yielded conflicting results. The aim of our ... ...

Abstract	Objective: Postoperative morbidity in patients undergoing lower extremity amputation (LEA) has remained high. Studies investigating the influence of the anesthetic modality on the postoperative outcomes have yielded conflicting results. The aim of our study was to assess the effects of regional anesthesia vs general anesthesia on postoperative complications for patients undergoing LEA. Methods: We systematically searched PubMed, Embase, MEDLINE, Web of Science, and Google Scholar from 1990 to 2022 for studies investigating the effect of the anesthetic modality on the postoperative outcomes after LEA. Regional anesthesia (RA) included neuraxial anesthesia and peripheral nerve blocks. The outcomes included 30-day mortality, respiratory failure (unplanned postoperative intubation, failure to wean, mechanical ventilation >24 hours), surgical site infection, cardiac complications, urinary tract infection, renal failure, sepsis, venous thrombosis, pneumonia, and myocardial infarction. Results: Of the 25 studies identified, we included 10 retrospective observational studies with 81,736 patients, of whom 69,754 (85.3%) had received general anesthesia (GA) and 11,980 (14.7%) had received RA. In the GA group, 50,468 patients were men (63.8%), and in the RA group, 7813 patients were men (62.3%). The results of the meta-analyses revealed that GA was associated with a higher rate of respiratory failure (odds ratio, 1.38; 95% confidence interval, 1.06-1.80; P = .02) and sepsis (odds ratio, 1.21; 95% confidence interval, 1.11-1.33; P < .0001) compared with RA. No differences were found in postoperative 30-day mortality, surgical site infection, cardiac complications, urinary tract infection, renal failure, venous thrombosis, pneumonia, and myocardial infarction between the GA and RA groups. Conclusions: The results of our meta-analysis have shown that GA could be associated with a higher rate of respiratory failure and sepsis compared with RA for LEA.
MeSH term(s)	Male ; Humans ; Female ; Surgical Wound Infection ; Retrospective Studies ; Treatment Outcome ; Anesthesia, Conduction/adverse effects ; Amputation, Surgical/adverse effects ; Pneumonia/complications ; Myocardial Infarction ; Anesthesia, General/adverse effects ; Lower Extremity/surgery ; Respiratory Insufficiency/complications ; Postoperative Complications/etiology
Language	English
Publishing date	2022-10-13
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2022.10.005
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Article ; Online: Geometric Indices for Predicting Ischemic Mitral Regurgitation: Correlation of Mitral Valve Coaptation Area With Tenting Height, Tenting Area and Tenting Volume.

Mufarrih, Syed Hamza / Sharkey, Aidan / Mahmood, Feroze / Yunus, Rayaan Ahmed / Qureshi, Nada Qaisar / Senthilnathan, Venkatachalam / Chu, Louis / Liu, David / Khabbaz, Kamal

Journal of cardiothoracic and vascular anesthesia

2022 Volume 37, Issue 1, Page(s) 8–15

Abstract: Objectives: Ischemic remodeling of the left ventricle in patients with coronary artery disease (CAD) results in geometric changes of the mitral valve (MV) apparatus, leading to reduced MV leaflet coaptation. Although the calculation of the coaptation ... ...

Abstract	Objectives: Ischemic remodeling of the left ventricle in patients with coronary artery disease (CAD) results in geometric changes of the mitral valve (MV) apparatus, leading to reduced MV leaflet coaptation. Although the calculation of the coaptation area has value in assessing the effects of left ventricular remodeling on the MV, it is difficult and time-consuming to measure. In this study the authors hypothesized that the tenting volume (TV) would have a greater association with coaptation area than tenting height (TH) or tenting area (TA). Design: A retrospective review. Setting: A single tertiary-care academic hospital. Participants: There were 145 adult patients who underwent coronary artery bypass graft surgery between April 2018 and July 2020. Measurements and main results: Intraoperative 2- and 3-dimensional transesophageal echocardiographic studies were obtained in the precardiopulmonary bypass period. Offline analysis was used to obtain TH, TA, TV and coaptation area for each patient. Correlation between the coaptation area and the TH, TA, and TV was conducted using Pearson's correlation. The median age of the population was 68.0 years (61.0-73.3), the body mass index was 29.0 kg/m Conclusion: As a representative of the complete topography of the MV, the authors' study demonstrated that in patients with CAD, TV has a greater negative correlation with coaptation area as compared to TH or TA.
MeSH term(s)	Adult ; Female ; Humans ; Aged ; Male ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Echocardiography, Three-Dimensional/methods ; Echocardiography, Transesophageal/methods ; Ventricular Remodeling ; Ischemia ; Coronary Artery Disease
Language	English
Publishing date	2022-10-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2022.10.003
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Article ; Online: Comprehensive Training Model for Procedural Guidance of Transcatheter Mitral Valve Edge-to-Edge Repair: Divide and Conquer Approach.

Derry, Kendra / Rehman, Taha A / Sharkey, Aidan / Laham, Roger J / Katsiampoura, Anastasia / Yunus, Rayaan Ahmed / Sohail, Mahnoor / Mahmood, Feroze / Mahboobi, Sohail K / Bose, Ruma R

Journal of cardiothoracic and vascular anesthesia

2023 Volume 37, Issue 11, Page(s) 2194–2203

Abstract: Transcatheter edge-to-edge repair (TEER) of the mitral valve is a complex procedure requiring continuous image guidance with 2-dimensional and 3-dimensional transesophageal echocardiography. In this context, the role of the echocardiographer is of ... ...

Abstract	Transcatheter edge-to-edge repair (TEER) of the mitral valve is a complex procedure requiring continuous image guidance with 2-dimensional and 3-dimensional transesophageal echocardiography. In this context, the role of the echocardiographer is of paramount importance. Training in interventional echocardiography for procedures such as TEER requires comprehending the complicated workflow of the hybrid operating room and advanced imaging skills that go beyond traditional echocardiography training to guide the procedure. Despite TEER being more commonly performed, the training structure for interventional echocardiographers is lagging, with many practitioners not having any formal training in image guidance for this procedure. In this context, novel training strategies must be developed to increase exposure and aid training. In this review, the authors present a step-wise approach to training for image guidance during TEER of the mitral valve. The authors have deconstructed this complex procedure into modular components and have incremental stages of training based on different steps of the procedure. At each step, trainees must demonstrate proficiency before advancing to the next step, thus ensuring a more structured approach to attaining proficiency in this complex procedure.
MeSH term(s)	Humans ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Cardiac Catheterization/methods ; Cardiac Surgical Procedures ; Echocardiography ; Heart Valve Prosthesis Implantation/methods ; Treatment Outcome
Language	English
Publishing date	2023-05-16
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.05.018
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Article ; Online: A Multidisciplinary Protocolized Approach for Ruptured Abdominal Aortic Aneurysm Management: A Retrospective Before-After Study.

Yunus, Rayaan A / Saeed, Shirin / Levy, Nadav / Di Fenza, Raffaele / Sharkey, Aidan / Pobywajlo, Susan / Liang, Patric / Schermerhorn, Marc / Mahmood, Feroze / Matyal, Robina / Neves, Sara

Journal of cardiothoracic and vascular anesthesia

2023 Volume 38, Issue 3, Page(s) 755–770

Abstract: Objectives: To investigate whether implementation of a multidisciplinary protocol for ruptured abdominal aortic aneurysm (rAAA) management reduces rates of adverse complications.: Design: A retrospective before-after study.: Setting: A tertiary- ... ...

Abstract	Objectives: To investigate whether implementation of a multidisciplinary protocol for ruptured abdominal aortic aneurysm (rAAA) management reduces rates of adverse complications. Design: A retrospective before-after study. Setting: A tertiary-care academic hospital. Participants: Adult patients who underwent open or endovascular rAAA repair; data were stratified into before-protocol implementation (group 1: 2015-2018) and after-protocol implementation (group 2: 2019-2022) groups. Intervention: The protocol details the workflow for vascular surgery, anesthesia, emergency department, and operating room staff for a rAAA case; training was accomplished through yearly workshops. Measurements and main results: The primary outcome was in-hospital mortality. Secondary outcomes included all-cause morbidity and other major complications. Differences in postoperative complication rates between groups were assessed using Pearson's χ Conclusions: Implementation of a multidisciplinary protocol for the management of a rAAA may reduce rates of adverse complications and improve the quality of care.
MeSH term(s)	Humans ; Retrospective Studies ; Controlled Before-After Studies ; Aortic Aneurysm, Abdominal/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Endovascular Procedures/methods ; Treatment Outcome ; Aortic Rupture/surgery ; Postoperative Complications/etiology ; Risk Factors
Language	English
Publishing date	2023-12-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.12.015
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Article ; Online: Novel Three-Dimensionally Printed Ultrasound Probe Simulator and Heart Model for Transthoracic Echocardiography Education.

Bu, Yifan / Sharkey, Aidan / Bose, Ruma / Rehman, Taha Abdul / Saeed, Shirin / Khan, Adnan / Yunus, Rayaan / Mahmood, Feroze / Matyal, Robina / Neves, Sara

Journal of cardiothoracic and vascular anesthesia

2023 Volume 37, Issue 9, Page(s) 1813–1818

Abstract: Simulation-based training is an essential component in the education of transthoracic echocardiography (TTE). Nevertheless, current TTE teaching methods may be subject to certain limitations. Hence, the authors in this study aimed to invent a novel TTE ... ...

Abstract	Simulation-based training is an essential component in the education of transthoracic echocardiography (TTE). Nevertheless, current TTE teaching methods may be subject to certain limitations. Hence, the authors in this study aimed to invent a novel TTE training system employing three-dimensional (3D) printing technology to teach the basic principles and psychomotor skills of TTE imaging more intuitively and understandably. This training system comprises a 3D-printed ultrasound probe simulator and a sliceable heart model. The probe simulator incorporates a linear laser generator to enable the visualization of the projection of the ultrasound scan plane in a 3D space. By using the probe simulator in conjunction with the sliceable heart model or other commercially available anatomic models, trainees can attain a more comprehensive understanding of probe motion and related scan planes in TTE. Notably, the 3D-printed models are portable and low-cost, suggesting their potential utility in various clinical scenarios, particularly for just-in-time training.
MeSH term(s)	Humans ; Echocardiography/methods ; Ultrasonography ; Heart/diagnostic imaging ; Models, Anatomic ; Printing, Three-Dimensional
Language	English
Publishing date	2023-05-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.05.007
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Article ; Online: Overview of the Interatrial Septum: Review of Cardiac Nomenclature for Transseptal Puncture.

Mufarrih, Syed H / Yunus, Rayaan A / Rehman, Taha A / Montealegre-Gallegos, Mario / Bose, Ruma / Mahboobi, Sohail K / Qureshi, Nada Q / Sharkey, Aidan / Mahmood, Feroze

Journal of cardiothoracic and vascular anesthesia

2023 Volume 37, Issue 6, Page(s) 988–999

Abstract: Transseptal puncture is an increasingly common procedure undertaken to gain access to the left side of the heart during structural heart disease interventions. Precision guidance during this procedure is paramount to ensure success and patient safety. As ...

Abstract	Transseptal puncture is an increasingly common procedure undertaken to gain access to the left side of the heart during structural heart disease interventions. Precision guidance during this procedure is paramount to ensure success and patient safety. As such, multimodality imaging, such as echocardiography, fluoroscopy, and fusion imaging, is routinely used to guide safe transseptal puncture. Despite the use of multimodal imaging, there is currently no uniform nomenclature of cardiac anatomy between the various imaging modes and proceduralists, and echocardiographers tend to use imaging modality-specific terminology when communicating among the various imaging modes. This variability in nomenclature among imaging modes stems from differing anatomic descriptions of cardiac anatomy. Given the required level of precision in performing transseptal puncture, a clearer understanding of the basis of cardiac anatomic nomenclature is required by both echocardiographers as well as proceduralists; enhanced understanding can help facilitate communication across specialties and possibly improve communication and safety. In this review, the authors highlight the variation in cardiac anatomy nomenclature among various imaging modes.
MeSH term(s)	Humans ; Cardiac Catheterization/methods ; Atrial Septum/diagnostic imaging ; Atrial Septum/surgery ; Echocardiography/methods ; Heart Diseases ; Punctures/methods ; Catheter Ablation
Language	English
Publishing date	2023-02-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2023.02.005
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