Residents/fellows often ask if ✍️ a review paper is worthwhile.

👇a short🧵with pros/cons/tips on writing review articles.

#MedTwitter #AcademicChatter #MedStudentTwitter #MedEd
Is ✍️ a review a good idea?

Short answer: yes

Pros:
1. No resources/funding required
2. Gain in-depth knowledge in a specific area
3. SOA reviews are highly cited
4. Excellent venue to hone✍️skills

Cons:
1. Time consuming
2. Not a substitute 4 original🔬
3. Unpredictable fate
How do I select a topic?

1. ✍️ on broad topics if no good 📝 exist (eg, SCAD, aneurysms, TV interventions), or if u find a novel angle (eg, stakeholder perspectives on stroke prevention in AF)

2. ✍️ on niche areas (eg, electrosurgery, ICE for LAAO, TAVR leaflet thrombosis)
What makes a review state-of-the-art review?

✔️Regular reviews read like book chapters (background, main text/data summary, conclusions)

✔️SOA are mentally stimulating 🖼 pieces (connect past & present w future, rich illustrations, highlight open issues & suggest solutions)
Is doing a systematic review better than SOA?

Depends on topic & intended message

👇aim was to🔦 lack of credible data on tissue valve durability

Great choice👍🏼This is best done w SR>SOA

The SR documented 11 definitions 4 valve durability w limited f/u
pubmed.ncbi.nlm.nih.gov/30516815/
How do I make my SOA ‘richly’ illustrated?

✔️Make unique figures:

1. Multipart figures easily doable with PPT
2. Special illustrations require an illustrator. If your🏥 doesn’t have one, hire one. I paid out of pocket for👇in the past. Totally worth it!

doi.org/10.1016/j.jcin…
3. Remember that u can reproduce excellent existing figures with permission

Obtaining permission is simple & free when the borrowed figure:

a) is published in an open access journal
b) is published by the same intended publisher of your current/future work (e.g., Elsevier)👇
✔️ Add videos when possible.

You can make the videos more appealing by combining, trimming, adding arrow/text & even narrating!

This could be done at low cost w commercial softwares👇(I use Movavi video editor). You can master the software in a few hrs

jacc.org/doi/10.1016/j.…
How do u link past, present & future?

1st section should include unique historical perspectives

Last section should summarize what u think ll happen in 5-10 yrs

Best way 2 piece a futuristic outlook together is to (a) discuss w mentors; (b) listen to Q&A at scientific meetings
In Summary

📌 ✍️ reviews is a fun learning experience 4 students, trainees & early career physicians

📌 With modest extra efforts u can upgrade a review to a SOA review

📌✍️ SOA reviews forces u to deep dive, develop expertise & build u portfolio even when resources r limited

• • •

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More from @adnanalkhouli

Feb 12
All you need to know about residual peri-device leaks (PDLs) after LAA occlusion in this 🧵

💢How frequent?
💢Do they matter?
💢What’s their mechanism?
💢Best way to manage?

#CardioTwitter #MedEd #EPeeps
How frequent? It depends on how you define PDL!

📌 In PROTECT AF, any PDL at 45d was 41% but ⬇️ to 32% at 1yr (2/3 of leaks ≥3mm)

📌 In Amulet IDE, any PDL at 45d was 51% w Watchman & 36% w Amulet

📌 In PINNACLE FLX, any PDL w Watchman FLX was 17% at 45d & ⬇️ to 10.5% at 1yr
Do PDLs matter?

📌 Till recently, we thought they don’t based on early data from PROTECT AF, Amulet registry, etc.

📌 However, data presented at AHA showed that PDLs at 1yr were associated w worse 5yr outcomes

📌@cellisvandyep also recently showed worse outcomes w PDLs
Read 7 tweets
Feb 5
🧵Step-by-Step ICE-guided MitraClip

1/8 Transseptal puncture

📌3D ICE allows biplane imaging - ⬆️ TSP precision

📌ICE>TEE in presence of septal occluders (visualize infer-pos FO)

📌 Measuring TSP-MV height is feasible w a modest learning curve

#CardioTwitter #MedEd
2/8 Baseline Assessment of MR

📌 After dilating the septum, cross with ICE to LAA —> insert the CDS

📌 Biplane imaging here displays two views identical to the LVOT/commissural views on TEE
3/8 Quality of Grasping⛔️

This👇is NOT a good grasp - see posterior leaflet curling. Don’t take it! high risk of SLDA
Read 8 tweets
Feb 2
AV Rails are useful in complex paravalvular leak closure, but not commonly discussed in the literature

This short🧵sheds some light on AV rails & their attributes.

#CardioTwitter #MedEd Image
💢When should I I use a rail?

📌 Simple leaks don’t require a rail

📌 Rail upfront in serpiginous/Ca++ leaks. I use it in 1/3 of cases. When in doubt, use a rail!

📌 Rails are also great opportunity to ‘electively’ master snaring 😉

But sometimes rails can be challenging👇
💢 e.g. Presence of 2 mechanical valves. Here u have 3 options:

1. Transapical rail
Caveat: TA🩸risk

2. AV rail across the mechanical AV
Caveat: leaflet impingement (can often be done carefully)

3. VV rail if double MV leaks: (aka LAMPOON style)
Caveat: valve instability
Read 6 tweets
Jan 29
🧵TV surgery

1/5 What to do with ‘moderate’ TR during mitral surgery?

🤔Rational to fix: Already there & TR may not get better

🧐Rational not to fix: TR may get better, ⬆️ CPB time, ⬆️ pacer risk, may end up w valve replacement

A new RCT tried to help us. What did it show?👇 Image
2/5

Previously, no RCT data existed ➡️ variable TV repair rate (5-75%)

💢401 DMR pts ➡️ MV surgery (>85% repair) vs MV surgery+TV ring

💢To qualify, pts needed moderate TR or TV annulus >4cm

💢1 endpoint: reoperation for TR, TR progression by 2 grades or to severe, or death Image
3/5

💢The primary end point was lower in the MV+TV surgery arm (3.9% vs. 10.2%) (RR 0.37; 95%CI 0.16-0.86)

💢However, this was purely driven by ⬇️ TR progression. There was no difference in redo surgery or ☠️

💢 TV surgery also came at a cost of ⬆️ pacemaker (14.1% vs. 2.5%) Image
Read 5 tweets
Nov 29, 2020
A med student asked: why do we need epicardial coronary arteries? Can’t the ❤️ utilize the abundant oxygenated blood within it? We then talked about transmyocardial revasc (TMR), which apparently has resurfaced some recently. Thought I’ll summarize my read on it in this thread 👇
1. TMR theory is based on reptilian circulation. Reptiles are devoid of epicardial arteries & hence rely on intramyocardial sinusoids for tissue oxygenation.
2. 1st TMR attempt (sort of) was by Claude Beck in 1935. Beck noted that external myocardial injury > new vessel formation
3. In 1970s myocardial needle acupuncture was attempted to replicate reptilian circulation. However, the created channels prematurely closed w fibrous growth.
4- In 1980s laser was introduced to increase channel patency. This was thought to be a game changer for refractory angina
Read 4 tweets

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