James Greelish - Academia.edu (original) (raw)

Papers by James Greelish

Research paper thumbnail of Atrial Natriuretic Factor Concentrations During Pregnancy and in the Postpartum Period

American Journal of Perinatology, Jul 1, 1992

Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. In... more Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. Increased intra-atrial pressure or atrial distention, which might occur secondary to intravascular volume expansion, stimulate the secretion of ANF by human atrial myocytes. During normal human pregnancy, there is a progressive increase in total intravascular fluid volume. Thus, we asked the following question: Does this physiologic adaptation to pregnancy result in an increase in ANF concentrations? Concentrations of alpha-human ANF (alpha-hANF) were measured by a specific radioimmunoassay in venous blood samples obtained longitudinally in the first, second, and third trimesters of pregnancy, during the intrapartum period, in the early postpartum period, and 6 to 8 weeks postpartum from 11 normal women who had no antepartum, intrapartum, or postpartum complications. Maternal circulating alpha-hANF levels were not different from those seen in the nonpregnant state. However, higher alpha-hANF concentrations were noted in the early postpartum period. Although the hypervolemia of normal pregnancy is not associated with higher alpha-hANF concentrations, other possibilities (such as increased ANF clearance, dilutional effects) need to be investigated. Finally, the etiology for the transient increase in alpha-hANF levels in the early postpartum period remains to be elucidated.

Research paper thumbnail of Atrial natriuretic factor maternal and fetal concentrations in severe preeclampsia

American Journal of Obstetrics and Gynecology, Oct 1, 1989

There is a reduction in intravascular volume in patients with preeclampsia. Since the secretion o... more There is a reduction in intravascular volume in patients with preeclampsia. Since the secretion of atrial natriuretic factor by human atrial myocytes is stimulated by increased intraatrial pressure or atrial distention, we sought to determine whether circulating maternal plasma atrial natriuretic factor concentrations were lower in patients with preeclampsia compared to normal pregnant women. The level of a-human atrial natriuretic factor was measured by a specific radioimmunoassay. Maternal venous concentrations of a a-human atrial natriuretic factor were higher in patients with severe preeclampsia (116.12:!: 13.37 pg/ml) than in normal pregnant women (80.30 ::!: 4.02 pg / ml). Umbilical artery a-human atrial natriuretic factor concentrations were higher in fetuses born to patients with severe preeclampsia (197.68 ::!: 29.10 pg/ml) than normal control subjects (118.00 ::!: 12.52 pg / ml). Umbilical artery a-human atrial natriuretic factor concentrations were higher than umbilical or maternal venous concentrations. In cases of severe preeclampsia, despite the presumed volume changes, maternal atrial natriuretic factor concentrations are higher than in normal pregnant women. The fetus appears to produce its own atrial natriuretic factor. Umbilical artery atrial natriuretic factor concentrations in fetuses born to preeclamptic mothers are higher than those seen in normal control subjects.

Research paper thumbnail of In Vivo Expression of Full-Length Human Dystrophin from Adenoviral Vectors Deleted of All Viral Genes

Human Gene Therapy, Oct 1, 1996

Research paper thumbnail of In Vivo Expression of Full-Length Human Dystrophin from Adenoviral Vectors Deleted of All Viral Genes

Research paper thumbnail of Atrial Natriuretic Factor Concentrations During Pregnancy and in the Postpartum Period

American Journal of Perinatology, 1992

Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. In... more Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. Increased intra-atrial pressure or atrial distention, which might occur secondary to intravascular volume expansion, stimulate the secretion of ANF by human atrial myocytes. During normal human pregnancy, there is a progressive increase in total intravascular fluid volume. Thus, we asked the following question: Does this physiologic adaptation to pregnancy result in an increase in ANF concentrations? Concentrations of alpha-human ANF (alpha-hANF) were measured by a specific radioimmunoassay in venous blood samples obtained longitudinally in the first, second, and third trimesters of pregnancy, during the intrapartum period, in the early postpartum period, and 6 to 8 weeks postpartum from 11 normal women who had no antepartum, intrapartum, or postpartum complications. Maternal circulating alpha-hANF levels were not different from those seen in the nonpregnant state. However, higher alpha-hANF concentrations were noted in the early postpartum period. Although the hypervolemia of normal pregnancy is not associated with higher alpha-hANF concentrations, other possibilities (such as increased ANF clearance, dilutional effects) need to be investigated. Finally, the etiology for the transient increase in alpha-hANF levels in the early postpartum period remains to be elucidated.

Research paper thumbnail of Atrial natriuretic factor maternal and fetal concentrations in severe preeclampsia

American Journal of Obstetrics and Gynecology, 1989

There is a reduction in intravascular volume in patients with preeclampsia. Since the secretion o... more There is a reduction in intravascular volume in patients with preeclampsia. Since the secretion of atrial natriuretic factor by human atrial myocytes is stimulated by increased intraatrial pressure or atrial distention, we sought to determine whether circulating maternal plasma atrial natriuretic factor concentrations were lower in patients with preeclampsia compared to normal pregnant women. The level of a-human atrial natriuretic factor was measured by a specific radioimmunoassay. Maternal venous concentrations of a a-human atrial natriuretic factor were higher in patients with severe preeclampsia (116.12:!: 13.37 pg/ml) than in normal pregnant women (80.30 ::!: 4.02 pg / ml). Umbilical artery a-human atrial natriuretic factor concentrations were higher in fetuses born to patients with severe preeclampsia (197.68 ::!: 29.10 pg/ml) than normal control subjects (118.00 ::!: 12.52 pg / ml). Umbilical artery a-human atrial natriuretic factor concentrations were higher than umbilical or maternal venous concentrations. In cases of severe preeclampsia, despite the presumed volume changes, maternal atrial natriuretic factor concentrations are higher than in normal pregnant women. The fetus appears to produce its own atrial natriuretic factor. Umbilical artery atrial natriuretic factor concentrations in fetuses born to preeclamptic mothers are higher than those seen in normal control subjects.

Research paper thumbnail of Interrelationship between atrial natriuretic factor concentrations and acute volume expansion in pregnant and nonpregnant women

American Journal of Obstetrics and Gynecology, 1990

The secretion of atrial natriuretic factor by human atrial myocytes is stimulated by increased in... more The secretion of atrial natriuretic factor by human atrial myocytes is stimulated by increased intraatrial pressure or atrial distention. To determine whether acute intravascular volume expansion affects atrial natriuretic factor concentrations during pregnancy, circulating atrial natriuretic factor levels were measured in pregnant women at term (before elective cesarean section) and nonpregnant control subjects before and dur:ng intravenous infusion of lactated Ringer's solution (approximately 30 ml/kg). Venous plasma concentrations of a-human atrial natriuretic factor were determined by a specific radioimmunoassay. A significant increase in a-human atrial natriuretic factor levels in nonpregnant subjects was seen. Pregnant women did not show a significant response to a similar stimulus. Finally, basal a-human atrial natriuretic factor levels in pregnant and nonpregnant women were not different. Volume expansion (long-term or short-term) in normal human pregnancy may not be sensed by atrial volume sensors, possibly because it is accommodated by an enlarged maternal vascular compartment.

Research paper thumbnail of Paraesophageal Hernia

New England Journal of Medicine, 2004

Research paper thumbnail of Argatroban in Short-Term Percutaneous Ventricular Assist Subsequent to Heparin-Induced Thrombocytopenia

The Journal of ExtraCorporeal Technology

Heparin-induced thrombocytopenia paradoxically is a transient pro-thrombotic disorder triggered b... more Heparin-induced thrombocytopenia paradoxically is a transient pro-thrombotic disorder triggered by heparin exposure. If not treated appropriately, it can be life threatening because of its related thromboembolic complications. In particular, it presents a unique challenge in patients needing extracorporeal life support, because anticoagulation is essential for safe management. This case report describes the safe, efficacious use of Argatroban during short-term support of a patient with a percutaneously inserted left ventricular assist TandemHeart device.

Research paper thumbnail of Abstract 16499: Preamyloid Oligomers are Present in Human Atrium and Are Associated With Post-Operative Atrial Fibrillation

Circulation, Nov 22, 2011

Research paper thumbnail of Abstract 2464: "One Stop" Hybrid Percutaneous Coronary Intervention (PCI) with Coronary Artery Bypass Graft (CABG) vs. Standard CABG

Circulation, Oct 31, 2006

Research paper thumbnail of Perkütan koroner girişim ile kapak cerrahisinin birlikte kullanımı

Current Opinion in Cardiology, 2006

Research paper thumbnail of Abstract 2117: Intra-Operative Completion Angiography After CABG with Immediate Percutaneous or Surgical Revision of Defects: One Year Experience from the Vanderbilt Hybrid Catheterization and Operating Room

Circulation, Oct 31, 2006

Research paper thumbnail of Stable restoration of the sarcoglycan complex in dystrophic muscle perfused with histamine and a recombinant adeno-associated viral vector

Nature medicine, 1999

Limb-girdle muscular dystrophies 2C-F represent a family of autosomal recessive diseases caused b... more Limb-girdle muscular dystrophies 2C-F represent a family of autosomal recessive diseases caused by defects in sarcoglycan genes. The cardiomyopathic hamster is a naturally occurring model for limb-girdle muscular dystrophy caused by a primary deficiency in delta-sarcoglycan. We show here that acute sarcolemmal disruption occurs in this animal model during forceful muscle contraction. A recombinant adeno-associated virus vector encoding human delta-sarcoglycan conferred efficient and stable genetic reconstitution in the adult cardiomyopathic hamster when injected directly into muscle. A quantitative assay demonstrated that vector-transduced muscle fibers are stably protected from sarcolemmal disruption; there was no associated inflammation or immunologic response to the vector-encoded protein. Efficient gene transduction with rescue of the sarcoglycan complex in muscle fibers of the distal hindlimb was also obtained after infusion of recombinant adeno-associated virus into the femora...

Research paper thumbnail of Use of the PercuSurge GuardWire distal balloon occlusion system as an endovascular clamp during off-pump coronary bypass surgery with the LIMA to the LAD

The Journal of invasive cardiology, 2006

Off-pump coronary bypass surgery is an alternative to conventional bypass surgery and has the pot... more Off-pump coronary bypass surgery is an alternative to conventional bypass surgery and has the potential to reduce perioperative morbidity. Current techniques of snaring or inserting a shunt into the coronary artery to occlude flow and allow for anastomotic construction carry the risk of vessel trauma and subsequent graft failure. We present two cases in which PercuSurge GuardWires were used as an endovascular clamp in a hybrid operating room/catheterization laboratory to transiently occlude flow down the native left anterior descending artery during left internal mammary artery anastamotic construction.

Research paper thumbnail of Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery

The Journal of heart valve disease, 2010

The study aim was to determine the safety and benefits of minimally invasive mitral valve surgery... more The study aim was to determine the safety and benefits of minimally invasive mitral valve surgery without aortic cross-clamping for mitral valve surgery after previous cardiac surgery. Between January 2006 and August 2008, a total of 90 consecutive patients (38 females, 52 males; mean age 66 +/- 9 years) underwent minimally invasive mitral valve surgery after having undergone previous cardiac surgery. Of these patients, 80 (89%) underwent mitral valve replacement and 10 (11%) mitral valve repair utilizing a small (5 cm) right lateral thoracotomy along the 4th or 5th intercostal space under fibrillatory arrest (mean temperature 28 +/- 2 degrees C). The predicted mortality, calculated using the Society of Thoracic Surgeons (STS) algorithm, was compared to the observed mortality. The mean ejection fraction was 45 +/- 13%, mean NYHA class 3 +/- 1, while 66 patients (73%) had previous coronary artery bypass grafting and 37 (41%) had previous valve surgery. Twenty-six patients (29%) under...

Research paper thumbnail of Minimally invasive mitral valve repair suggests earlier operations for mitral valve disease

The Journal of Thoracic and Cardiovascular Surgery, 2003

We began minimally invasive mitral valve surgery in August, 1996, to reduce hospital costs, to im... more We began minimally invasive mitral valve surgery in August, 1996, to reduce hospital costs, to improve patient recovery, cosmetic appearance, and to decrease trauma, yet maintain the same quality of surgery. To validate this approach we reviewed our entire experience through May 2002. Methods: From August 1996 to May 2002, we performed 413 minimally invasive mitral valve operations including 51 mitral valve replacements and 362 mitral valve repairs. Excluding 4 robotically assisted repairs, we evaluated 358 patients, using the mitral valve repairs as the basis for this retrospective survey. These operations were performed through a 6-to 8-cm minimally invasive incision, beginning with parasternal and, most recently, lower ministernotomy (181 patients). The mitral valve reparative techniques include repair of 94 prolapsed anterior leaflets, posterior leaflet resection, leaflet advancement, commissuroplasty, Polytetrafluoroethylene (PTFE; Gore-Tex, W. L. Gore & Associates, Inc, Flagstaff, Ariz) chordal placement, and ring annuloplasty. Cannulation sites varied but primarily utilized a miniaturized system of 24F catheters in both the inferior and superior venae cavae with assisted venous suction. The Cosgrove ring was used in 95% of the patients undergoing this procedure. Results: The operative mortality was 0/358. Perioperative morbidity included a 26% incidence of new atrial fibrillation, 2% incidence of pacemaker implantation, 0.5% incidence of deep sternal wound infection, and 1.9% incidence of stroke after an operation. There were 10 arterial and 3 venous complications. The mean length of stay was 6 days and 208 patients stayed Յ5 days. Only 25% of the patients underwent homologous blood transfusion. The mean follow-up was 36 months with 1.4% lost to follow-up. There were 12 late deaths and a survival at 5 years of 95%. There were 21 valves requiring reoperation for structural valve failure of 5.8%. The probability of freedom from reoperation at 5 years was 92%. Conclusion: This study documents the safety of minimally invasive mitral valve repair surgery in 358 patients. It also documents a low incidence of homologous blood use, requirement for post-hospital rehabilitation, and general morbidity.

Research paper thumbnail of Poland syndrome: A contraindication to the use of the internal thoracic artery in coronary artery bypass grafting?

The Journal of Thoracic and Cardiovascular Surgery, 2005

Research paper thumbnail of Routine Intraoperative Completion Angiography After Coronary Artery Bypass Grafting and 1-Stop Hybrid Revascularization

Journal of the American College of Cardiology, 2009

This study sought to report our experience with a routine completion angiogram after coronary art... more This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room. Background The value of a routine completion angiogram after CABG and 1-stop hybrid CABG/PCI remains unresolved. Methods Between April 2005 and July 2007, 366 consecutive patients underwent CABG surgery, with (n ϭ 112) or without (n ϭ 254) concomitant 1-stop PCI (hybrid), all with completion angiography before chest closure. Among the 112 1-stop hybrid CABG/PCI patients, 67 (60%) underwent a planned hybrid procedure based on pre-operative assessment, whereas 45 (40%) underwent open-chest PCI (unplanned hybrid) based on intraoperative findings. Results Among the 796 CABG grafts (345 left internal mammary artery, 12 right internal mammary artery/radial, and 439 veins), 97 (12%) angiographic defects were identified. Defects were repaired with either a minor adjustment of the graft (n ϭ 22, 2.8%), with intraoperative open-chest PCI (unplanned hybrid, n ϭ 48, 6%) or with traditional surgical revision (n ϭ 27, 3.4%). Hybrid patients had clinical outcomes similar to standard CABG patients. Conclusions Routine completion angiography detected 12% of grafts with important angiographic defects. One-stop hybrid coronary revascularization is reasonable, safe, and feasible. Combining the tools of the catheterization laboratory and operating room greatly enhances the options available to the surgeon and cardiologist for patients with complex coronary artery disease.

Research paper thumbnail of Quantitative Imaging of Preamyloid Oligomers, a Novel Structural Abnormality, in Human Atrial Samples

Journal of Histochemistry & Cytochemistry, 2014

Abnormalities in atrial myocardium increase the likelihood of arrhythmias, including atrial fibri... more Abnormalities in atrial myocardium increase the likelihood of arrhythmias, including atrial fibrillation (AF). The deposition of misfolded protein, or amyloidosis, plays an important role in the pathophysiology of many diseases, including human cardiomyopathies. We have shown that genes implicated in amyloidosis are activated in a cellular model of AF, with the development of preamyloid oligomers (PAOs). PAOs are intermediates in the formation of amyloid fibrils, and they are now recognized to be the cytotoxic species during amyloidosis. To investigate the presence of PAOs in human atrium, we developed a microscopic imaging-based protocol to enable robust and reproducible quantitative analysis of PAO burden in atrial samples harvested at the time of elective cardiac surgery. Using PAO- and myocardial-specific antibodies, we found that PAO distribution was typically heterogeneous within a myocardial sample. Rigorous imaging and analysis protocols were developed to quantify the relati...

Research paper thumbnail of Atrial Natriuretic Factor Concentrations During Pregnancy and in the Postpartum Period

American Journal of Perinatology, Jul 1, 1992

Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. In... more Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. Increased intra-atrial pressure or atrial distention, which might occur secondary to intravascular volume expansion, stimulate the secretion of ANF by human atrial myocytes. During normal human pregnancy, there is a progressive increase in total intravascular fluid volume. Thus, we asked the following question: Does this physiologic adaptation to pregnancy result in an increase in ANF concentrations? Concentrations of alpha-human ANF (alpha-hANF) were measured by a specific radioimmunoassay in venous blood samples obtained longitudinally in the first, second, and third trimesters of pregnancy, during the intrapartum period, in the early postpartum period, and 6 to 8 weeks postpartum from 11 normal women who had no antepartum, intrapartum, or postpartum complications. Maternal circulating alpha-hANF levels were not different from those seen in the nonpregnant state. However, higher alpha-hANF concentrations were noted in the early postpartum period. Although the hypervolemia of normal pregnancy is not associated with higher alpha-hANF concentrations, other possibilities (such as increased ANF clearance, dilutional effects) need to be investigated. Finally, the etiology for the transient increase in alpha-hANF levels in the early postpartum period remains to be elucidated.

Research paper thumbnail of Atrial natriuretic factor maternal and fetal concentrations in severe preeclampsia

American Journal of Obstetrics and Gynecology, Oct 1, 1989

There is a reduction in intravascular volume in patients with preeclampsia. Since the secretion o... more There is a reduction in intravascular volume in patients with preeclampsia. Since the secretion of atrial natriuretic factor by human atrial myocytes is stimulated by increased intraatrial pressure or atrial distention, we sought to determine whether circulating maternal plasma atrial natriuretic factor concentrations were lower in patients with preeclampsia compared to normal pregnant women. The level of a-human atrial natriuretic factor was measured by a specific radioimmunoassay. Maternal venous concentrations of a a-human atrial natriuretic factor were higher in patients with severe preeclampsia (116.12:!: 13.37 pg/ml) than in normal pregnant women (80.30 ::!: 4.02 pg / ml). Umbilical artery a-human atrial natriuretic factor concentrations were higher in fetuses born to patients with severe preeclampsia (197.68 ::!: 29.10 pg/ml) than normal control subjects (118.00 ::!: 12.52 pg / ml). Umbilical artery a-human atrial natriuretic factor concentrations were higher than umbilical or maternal venous concentrations. In cases of severe preeclampsia, despite the presumed volume changes, maternal atrial natriuretic factor concentrations are higher than in normal pregnant women. The fetus appears to produce its own atrial natriuretic factor. Umbilical artery atrial natriuretic factor concentrations in fetuses born to preeclamptic mothers are higher than those seen in normal control subjects.

Research paper thumbnail of In Vivo Expression of Full-Length Human Dystrophin from Adenoviral Vectors Deleted of All Viral Genes

Human Gene Therapy, Oct 1, 1996

Research paper thumbnail of In Vivo Expression of Full-Length Human Dystrophin from Adenoviral Vectors Deleted of All Viral Genes

Research paper thumbnail of Atrial Natriuretic Factor Concentrations During Pregnancy and in the Postpartum Period

American Journal of Perinatology, 1992

Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. In... more Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. Increased intra-atrial pressure or atrial distention, which might occur secondary to intravascular volume expansion, stimulate the secretion of ANF by human atrial myocytes. During normal human pregnancy, there is a progressive increase in total intravascular fluid volume. Thus, we asked the following question: Does this physiologic adaptation to pregnancy result in an increase in ANF concentrations? Concentrations of alpha-human ANF (alpha-hANF) were measured by a specific radioimmunoassay in venous blood samples obtained longitudinally in the first, second, and third trimesters of pregnancy, during the intrapartum period, in the early postpartum period, and 6 to 8 weeks postpartum from 11 normal women who had no antepartum, intrapartum, or postpartum complications. Maternal circulating alpha-hANF levels were not different from those seen in the nonpregnant state. However, higher alpha-hANF concentrations were noted in the early postpartum period. Although the hypervolemia of normal pregnancy is not associated with higher alpha-hANF concentrations, other possibilities (such as increased ANF clearance, dilutional effects) need to be investigated. Finally, the etiology for the transient increase in alpha-hANF levels in the early postpartum period remains to be elucidated.

Research paper thumbnail of Atrial natriuretic factor maternal and fetal concentrations in severe preeclampsia

American Journal of Obstetrics and Gynecology, 1989

There is a reduction in intravascular volume in patients with preeclampsia. Since the secretion o... more There is a reduction in intravascular volume in patients with preeclampsia. Since the secretion of atrial natriuretic factor by human atrial myocytes is stimulated by increased intraatrial pressure or atrial distention, we sought to determine whether circulating maternal plasma atrial natriuretic factor concentrations were lower in patients with preeclampsia compared to normal pregnant women. The level of a-human atrial natriuretic factor was measured by a specific radioimmunoassay. Maternal venous concentrations of a a-human atrial natriuretic factor were higher in patients with severe preeclampsia (116.12:!: 13.37 pg/ml) than in normal pregnant women (80.30 ::!: 4.02 pg / ml). Umbilical artery a-human atrial natriuretic factor concentrations were higher in fetuses born to patients with severe preeclampsia (197.68 ::!: 29.10 pg/ml) than normal control subjects (118.00 ::!: 12.52 pg / ml). Umbilical artery a-human atrial natriuretic factor concentrations were higher than umbilical or maternal venous concentrations. In cases of severe preeclampsia, despite the presumed volume changes, maternal atrial natriuretic factor concentrations are higher than in normal pregnant women. The fetus appears to produce its own atrial natriuretic factor. Umbilical artery atrial natriuretic factor concentrations in fetuses born to preeclamptic mothers are higher than those seen in normal control subjects.

Research paper thumbnail of Interrelationship between atrial natriuretic factor concentrations and acute volume expansion in pregnant and nonpregnant women

American Journal of Obstetrics and Gynecology, 1990

The secretion of atrial natriuretic factor by human atrial myocytes is stimulated by increased in... more The secretion of atrial natriuretic factor by human atrial myocytes is stimulated by increased intraatrial pressure or atrial distention. To determine whether acute intravascular volume expansion affects atrial natriuretic factor concentrations during pregnancy, circulating atrial natriuretic factor levels were measured in pregnant women at term (before elective cesarean section) and nonpregnant control subjects before and dur:ng intravenous infusion of lactated Ringer's solution (approximately 30 ml/kg). Venous plasma concentrations of a-human atrial natriuretic factor were determined by a specific radioimmunoassay. A significant increase in a-human atrial natriuretic factor levels in nonpregnant subjects was seen. Pregnant women did not show a significant response to a similar stimulus. Finally, basal a-human atrial natriuretic factor levels in pregnant and nonpregnant women were not different. Volume expansion (long-term or short-term) in normal human pregnancy may not be sensed by atrial volume sensors, possibly because it is accommodated by an enlarged maternal vascular compartment.

Research paper thumbnail of Paraesophageal Hernia

New England Journal of Medicine, 2004

Research paper thumbnail of Argatroban in Short-Term Percutaneous Ventricular Assist Subsequent to Heparin-Induced Thrombocytopenia

The Journal of ExtraCorporeal Technology

Heparin-induced thrombocytopenia paradoxically is a transient pro-thrombotic disorder triggered b... more Heparin-induced thrombocytopenia paradoxically is a transient pro-thrombotic disorder triggered by heparin exposure. If not treated appropriately, it can be life threatening because of its related thromboembolic complications. In particular, it presents a unique challenge in patients needing extracorporeal life support, because anticoagulation is essential for safe management. This case report describes the safe, efficacious use of Argatroban during short-term support of a patient with a percutaneously inserted left ventricular assist TandemHeart device.

Research paper thumbnail of Abstract 16499: Preamyloid Oligomers are Present in Human Atrium and Are Associated With Post-Operative Atrial Fibrillation

Circulation, Nov 22, 2011

Research paper thumbnail of Abstract 2464: "One Stop" Hybrid Percutaneous Coronary Intervention (PCI) with Coronary Artery Bypass Graft (CABG) vs. Standard CABG

Circulation, Oct 31, 2006

Research paper thumbnail of Perkütan koroner girişim ile kapak cerrahisinin birlikte kullanımı

Current Opinion in Cardiology, 2006

Research paper thumbnail of Abstract 2117: Intra-Operative Completion Angiography After CABG with Immediate Percutaneous or Surgical Revision of Defects: One Year Experience from the Vanderbilt Hybrid Catheterization and Operating Room

Circulation, Oct 31, 2006

Research paper thumbnail of Stable restoration of the sarcoglycan complex in dystrophic muscle perfused with histamine and a recombinant adeno-associated viral vector

Nature medicine, 1999

Limb-girdle muscular dystrophies 2C-F represent a family of autosomal recessive diseases caused b... more Limb-girdle muscular dystrophies 2C-F represent a family of autosomal recessive diseases caused by defects in sarcoglycan genes. The cardiomyopathic hamster is a naturally occurring model for limb-girdle muscular dystrophy caused by a primary deficiency in delta-sarcoglycan. We show here that acute sarcolemmal disruption occurs in this animal model during forceful muscle contraction. A recombinant adeno-associated virus vector encoding human delta-sarcoglycan conferred efficient and stable genetic reconstitution in the adult cardiomyopathic hamster when injected directly into muscle. A quantitative assay demonstrated that vector-transduced muscle fibers are stably protected from sarcolemmal disruption; there was no associated inflammation or immunologic response to the vector-encoded protein. Efficient gene transduction with rescue of the sarcoglycan complex in muscle fibers of the distal hindlimb was also obtained after infusion of recombinant adeno-associated virus into the femora...

Research paper thumbnail of Use of the PercuSurge GuardWire distal balloon occlusion system as an endovascular clamp during off-pump coronary bypass surgery with the LIMA to the LAD

The Journal of invasive cardiology, 2006

Off-pump coronary bypass surgery is an alternative to conventional bypass surgery and has the pot... more Off-pump coronary bypass surgery is an alternative to conventional bypass surgery and has the potential to reduce perioperative morbidity. Current techniques of snaring or inserting a shunt into the coronary artery to occlude flow and allow for anastomotic construction carry the risk of vessel trauma and subsequent graft failure. We present two cases in which PercuSurge GuardWires were used as an endovascular clamp in a hybrid operating room/catheterization laboratory to transiently occlude flow down the native left anterior descending artery during left internal mammary artery anastamotic construction.

Research paper thumbnail of Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery

The Journal of heart valve disease, 2010

The study aim was to determine the safety and benefits of minimally invasive mitral valve surgery... more The study aim was to determine the safety and benefits of minimally invasive mitral valve surgery without aortic cross-clamping for mitral valve surgery after previous cardiac surgery. Between January 2006 and August 2008, a total of 90 consecutive patients (38 females, 52 males; mean age 66 +/- 9 years) underwent minimally invasive mitral valve surgery after having undergone previous cardiac surgery. Of these patients, 80 (89%) underwent mitral valve replacement and 10 (11%) mitral valve repair utilizing a small (5 cm) right lateral thoracotomy along the 4th or 5th intercostal space under fibrillatory arrest (mean temperature 28 +/- 2 degrees C). The predicted mortality, calculated using the Society of Thoracic Surgeons (STS) algorithm, was compared to the observed mortality. The mean ejection fraction was 45 +/- 13%, mean NYHA class 3 +/- 1, while 66 patients (73%) had previous coronary artery bypass grafting and 37 (41%) had previous valve surgery. Twenty-six patients (29%) under...

Research paper thumbnail of Minimally invasive mitral valve repair suggests earlier operations for mitral valve disease

The Journal of Thoracic and Cardiovascular Surgery, 2003

We began minimally invasive mitral valve surgery in August, 1996, to reduce hospital costs, to im... more We began minimally invasive mitral valve surgery in August, 1996, to reduce hospital costs, to improve patient recovery, cosmetic appearance, and to decrease trauma, yet maintain the same quality of surgery. To validate this approach we reviewed our entire experience through May 2002. Methods: From August 1996 to May 2002, we performed 413 minimally invasive mitral valve operations including 51 mitral valve replacements and 362 mitral valve repairs. Excluding 4 robotically assisted repairs, we evaluated 358 patients, using the mitral valve repairs as the basis for this retrospective survey. These operations were performed through a 6-to 8-cm minimally invasive incision, beginning with parasternal and, most recently, lower ministernotomy (181 patients). The mitral valve reparative techniques include repair of 94 prolapsed anterior leaflets, posterior leaflet resection, leaflet advancement, commissuroplasty, Polytetrafluoroethylene (PTFE; Gore-Tex, W. L. Gore & Associates, Inc, Flagstaff, Ariz) chordal placement, and ring annuloplasty. Cannulation sites varied but primarily utilized a miniaturized system of 24F catheters in both the inferior and superior venae cavae with assisted venous suction. The Cosgrove ring was used in 95% of the patients undergoing this procedure. Results: The operative mortality was 0/358. Perioperative morbidity included a 26% incidence of new atrial fibrillation, 2% incidence of pacemaker implantation, 0.5% incidence of deep sternal wound infection, and 1.9% incidence of stroke after an operation. There were 10 arterial and 3 venous complications. The mean length of stay was 6 days and 208 patients stayed Յ5 days. Only 25% of the patients underwent homologous blood transfusion. The mean follow-up was 36 months with 1.4% lost to follow-up. There were 12 late deaths and a survival at 5 years of 95%. There were 21 valves requiring reoperation for structural valve failure of 5.8%. The probability of freedom from reoperation at 5 years was 92%. Conclusion: This study documents the safety of minimally invasive mitral valve repair surgery in 358 patients. It also documents a low incidence of homologous blood use, requirement for post-hospital rehabilitation, and general morbidity.

Research paper thumbnail of Poland syndrome: A contraindication to the use of the internal thoracic artery in coronary artery bypass grafting?

The Journal of Thoracic and Cardiovascular Surgery, 2005

Research paper thumbnail of Routine Intraoperative Completion Angiography After Coronary Artery Bypass Grafting and 1-Stop Hybrid Revascularization

Journal of the American College of Cardiology, 2009

This study sought to report our experience with a routine completion angiogram after coronary art... more This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room. Background The value of a routine completion angiogram after CABG and 1-stop hybrid CABG/PCI remains unresolved. Methods Between April 2005 and July 2007, 366 consecutive patients underwent CABG surgery, with (n ϭ 112) or without (n ϭ 254) concomitant 1-stop PCI (hybrid), all with completion angiography before chest closure. Among the 112 1-stop hybrid CABG/PCI patients, 67 (60%) underwent a planned hybrid procedure based on pre-operative assessment, whereas 45 (40%) underwent open-chest PCI (unplanned hybrid) based on intraoperative findings. Results Among the 796 CABG grafts (345 left internal mammary artery, 12 right internal mammary artery/radial, and 439 veins), 97 (12%) angiographic defects were identified. Defects were repaired with either a minor adjustment of the graft (n ϭ 22, 2.8%), with intraoperative open-chest PCI (unplanned hybrid, n ϭ 48, 6%) or with traditional surgical revision (n ϭ 27, 3.4%). Hybrid patients had clinical outcomes similar to standard CABG patients. Conclusions Routine completion angiography detected 12% of grafts with important angiographic defects. One-stop hybrid coronary revascularization is reasonable, safe, and feasible. Combining the tools of the catheterization laboratory and operating room greatly enhances the options available to the surgeon and cardiologist for patients with complex coronary artery disease.

Research paper thumbnail of Quantitative Imaging of Preamyloid Oligomers, a Novel Structural Abnormality, in Human Atrial Samples

Journal of Histochemistry & Cytochemistry, 2014

Abnormalities in atrial myocardium increase the likelihood of arrhythmias, including atrial fibri... more Abnormalities in atrial myocardium increase the likelihood of arrhythmias, including atrial fibrillation (AF). The deposition of misfolded protein, or amyloidosis, plays an important role in the pathophysiology of many diseases, including human cardiomyopathies. We have shown that genes implicated in amyloidosis are activated in a cellular model of AF, with the development of preamyloid oligomers (PAOs). PAOs are intermediates in the formation of amyloid fibrils, and they are now recognized to be the cytotoxic species during amyloidosis. To investigate the presence of PAOs in human atrium, we developed a microscopic imaging-based protocol to enable robust and reproducible quantitative analysis of PAO burden in atrial samples harvested at the time of elective cardiac surgery. Using PAO- and myocardial-specific antibodies, we found that PAO distribution was typically heterogeneous within a myocardial sample. Rigorous imaging and analysis protocols were developed to quantify the relati...