Marius Berman - Academia.edu (original) (raw)
Papers by Marius Berman
The Annals of Thoracic Surgery, 2007
We describe a case of takotsubo cardiomyopathy in a 69-year-old woman after right upper lobectomy... more We describe a case of takotsubo cardiomyopathy in a 69-year-old woman after right upper lobectomy, without cardiac antecedents. The immediate course of recovery was uneventful. On the first postoperative day, clinical symptoms of acute coronary syndrome developed in association with ischemic electrocardiographic changes and a mild elevation in creatinine phosphokinase levels. Echocardiography showed moderate left ventricular dysfunction, with a typical takotsubo pattern. Coronary angiography revealed no abnormalities. After 2 days of supportive treatment, the patient recovered completely. The clinical presentation, instrumental findings, additional cardiac and noncardiac diseases, and the potential pathomechanism of takotsubo cardiomyopathy are described according to the current medical literature.
Transplantation, Feb 1, 2004
The availability of organ transplants depends largely on the will of the donor families. Given th... more The availability of organ transplants depends largely on the will of the donor families. Given the current state of affairs in Israel, the authors evaluated the stance of Jews and Arabs toward mutual organ donations. Between October 1997 and December 1999, there were 4.8 million Jews and 1.09 million Arabs living in Israel. Data gathered from 22 general hospitals for this period yielded 373 potential organ donors and 171 families (45.8%) that consented to the procedure. Actual donation was obtained from 157 patients. The authors examined the characteristics of the potential organ donors and organ recipients and the reasons (religious and nonreligious) for familial consent or refusal. Donation made since onset of the Intifada (armed Palestinian resistance) was also reviewed to determine whether any changes took place. Consent was obtained from 48.9% of the Jewish families approached, 30.7% of the Muslim Arabs, and 66.6% of the Christian Arabs. For the whole sample, altruism was the main reason for consenting. The percentages of Arabs and Jews (per population) on the waiting list for a heart (Jews, 90%; Arabs, 10%) or liver (Jews, 78.66%; Arabs, 21.34%) and who received a heart (Jews, 90%; Arabs, 10%) or liver (Jews, 78.36%; Arabs, 21.64%) were similar. There were relatively more Arab recipients of kidney transplants (waiting list, 11%; recipients, 18.6%) because of the higher percentage of children in the Arab group who were given priority. Since September 2000 (start of the Intifada), there has been a trend toward an increasing rate of refusal to donate among Arabs (consent obtained in 52.9% of Jewish families approached vs. 27.9% of the Muslim Arabs), mainly because of fear of rejection by the community for cooperating with Jews. The rate of organ donations among Arabs and Jews in Israel is proportional to their representation in the general population. The main reason for donating organs is altruism. Apparently, altruism cuts across the boundaries of religion and ethnic groups, even in a country where conflict prevails. We trust that progress in the international arena will bring the current cycle of violence to an end and allow humanitarian values to take preference over politics.
American Journal of Physiology Heart and Circulatory Physiology, Apr 1, 1991
Page 1. Estimated time course of Ca2+ bound to troponin C during relaxation in isolated cardiac m... more Page 1. Estimated time course of Ca2+ bound to troponin C during relaxation in isolated cardiac muscle JON N. PETERSON, WILLIAM C. HUNTER, AND MICHAEL R. BERMAN Department of Biomedical Engineering, The Johns ...
The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 mo... more The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 months, range 6 - 18 months) and value of transaxillary single-port thoracic sympathectomy using a thoracoscope with an operating channel for the treatment of hyperhidrosis. Between December 1992 and October 2002, 176 consecutive patients (94 men, 82 women, mean age 21 years) with hyperhidrosis underwent
J Heart Lung Transplant, 2008
http://ats.ctsnetjournals.org/cgi/content/full/76/2/601 located on the World Wide Web at:
Anesthesia and analgesia, Jan 27, 2015
Administration of coagulation factor concentrates to treat bleeding after cardiac surgery with ca... more Administration of coagulation factor concentrates to treat bleeding after cardiac surgery with cardiopulmonary bypass might be a strategy for reducing allogeneic blood transfusions, particularly for patients treated with warfarin preoperatively. We performed an exploratory analysis on whether the use of prothrombin complex concentrate (PCC) is safe and effective compared with fresh frozen plasma (FFP) to treat coagulopathy after pulmonary endarterectomy surgery with deep hypothermic circulatory arrest. Consecutive adult patients who underwent pulmonary endarterectomy surgery between January 2010 and September 2012 and received PCC or FFP to treat coagulopathy were studied. Blood loss during the first 12 hours of admission to the intensive care unit and patient outcomes were compared with propensity score adjustment. Three hundred fifty-one patients underwent pulmonary endarterectomy surgery, all of whom had warfarin discontinued for up to 5 days before surgery; bleeding complication...
BACKGROUND: Pulmonary thromboendarterectomy (PTE) is the treatment of choice for patients with ch... more BACKGROUND: Pulmonary thromboendarterectomy (PTE) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension. However, some patients develop severe cardiorespiratory compromise soon after separating from ...
The Journal of heart valve disease, 2005
Papillary fibroelastoma (PFE) is a rare and histologically benign tumor, but it may have malignan... more Papillary fibroelastoma (PFE) is a rare and histologically benign tumor, but it may have malignant propensity for life-threatening complications. Herein are described four cases of PFE which reflect the clinical diversity of this lesion. The diagnostic and surgical approach utilized is also briefly reviewed. The files of four patients with cardiac valvular PFE treated at the authors' center between January 2002 and November 2003 were reviewed. The diagnosis was strongly suggested by echocardiography. Tumors were noted in aortic (n = 2), mitral (n = 1) and tricuspid (n = 1) sites. Indications for surgery were myocardial infarction (both aortic tumors), previous stroke (mitral tumor), and preventive (tricuspid tumor). Surgical excision with a conservative, valve-sparing approach was performed in all cases. For the first aortic tumor, the aortic valve was reconstructed with a patch of autologous pericardium. None of the patients had evidence of valvular regurgitation after excision...
Interactive cardiovascular and thoracic surgery, 2004
The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 mo... more The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 months, range 6-18 months) and value of transaxillary single-port thoracic sympathectomy using a thoracoscope with an operating channel for the treatment of hyperhidrosis. Between December 1992 and October 2002, 176 consecutive patients (94 men, 82 women, mean age 21 years) with hyperhidrosis underwent thoracoscopic sympathectomy via a 12-mm single-port approach. Data on postoperative morbidity and outcome were analyzed to validate the technique. Mean operative time per side was 9 min; there was no conversion to an open procedure. Ninety-five percent of the patients were discharged the next day. Thirty-day mortality was zero. Complications included unilateral transient Horner's syndrome (n=1), residual pneumothorax requiring chest drainage from the port entry (n=4), and segmental atelectasis of the lung (n=4) which was treated conservatively. Complete relief of symptoms was observed in...
Interactive cardiovascular and thoracic surgery, 2005
Prior studies have suggested that inflammation and possibly bacterial infections play a role in a... more Prior studies have suggested that inflammation and possibly bacterial infections play a role in atherogenesis and in the clinical pathogenesis of cardiovascular diseases. Treatment with the macrolide antibiotics has been associated with improved outcome from cardiovascular disease, although the mechanism through which they exert their effects may be unrelated to their antibiotic properties. Drugs that exert a vasodilator effect on arteries have been associated with attenuated atherogenesis and improved outcome from cardiovascular disease. To determine the effect of the macrolide, roxithromycin (RX), on arterial vasoactivity. Human internal mammary artery (IMA) and rat thoracic aorta (TA) rings were placed in organ chambers and contracted with norepinephrine (NE). Endothelial and smooth muscle integrity were assessed using acetylcholine (ACh) and nitroprusside (SNP), respectively. After restabilization, the rings were exposed to 10(-6) M NE, followed by increasing concentrations of R...
The Annals of thoracic surgery, 2011
Untreated severe chronic thromboembolic pulmonary hypertension has a poor prognosis ending with r... more Untreated severe chronic thromboembolic pulmonary hypertension has a poor prognosis ending with right heart decompensation and multiorgan failure. This case report demonstrates that it is possible to intervene in the terminal stages of chronic thromboembolic pulmonary hypertension and bridge patients to surgery and recovery using various forms of extracorporeal membrane oxygenation support.
The European respiratory journal, 2014
Chronic thromboembolic disease is characterised by persistent pulmonary thromboembolic occlusions... more Chronic thromboembolic disease is characterised by persistent pulmonary thromboembolic occlusions without pulmonary hypertension. Early surgical treatment with pulmonary endarterectomy may improve symptoms and prevent disease progression. We sought to assess the outcome of pulmonary endarterectomy in symptomatic patients with chronic thromboembolic disease. Patients with symptomatic chronic thromboembolic disease and a mean pulmonary artery pressure <25 mmHg at baseline with right heart catheterisation and treated with pulmonary endarterectomy between January 2000 and July 2013 were identified. Patients were reassessed at 6 months and at 1 year following surgery. A total of 42 patients underwent surgery and the median length of stay in hospital was 11 days. There was no in-hospital mortality but complications occurred in 40% of patients. At 1 year, following surgery, 95% of the patients remained alive. There was a significant symptomatic improvement with 95% of patients in the Ne...
Pulmonary Circulation, 2014
The objective of this study was to assess the effect of pulmonary endarterectomy (PEA) on right v... more The objective of this study was to assess the effect of pulmonary endarterectomy (PEA) on right ventricular (RV) reverse remodeling using magnetic resonance imaging (MRI) and to correlate MRI findings with clinical and hemodynamic outcomes postsurgery. We performed a retrospective analysis in 72 patients undergoing PEA surgery in whom MRI and right heart catheterization (RHC) were performed preoperation and 3 months postoperation. RV volumes and mass were assessed by MRI. Continuous variables were expressed as means, changes were compared with a paired t test, and associations between the variables were explored using Pearson correlation coefficients. The mean age was 57 years, and 51% were male. Both RV end-diastolic volume (EDV; 176-117 mL; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and RV end-systolic volume (ESV; 129-64 mL; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) reduced significantly following PEA. Preoperative pulmonary artery pressure (PAP) correlated moderately with ESV (r = 0.46, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Postoperatively, PAP correlated with EDV (r = 0.45, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and ESV (r = 0.44, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Moderate correlation was present between hemodynamic parameters: PAP, pulmonary vascular resistance, and right atrial pressure with pre- and postoperation end-systolic and end-diastolic RV mass (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). RHC and MRI measurements of cardiac output and RV volumes were significantly different (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In conclusion, RV reverse remodeling, as measured by improvement in RV volumes and mass by MRI, was observed for 3 months in patients who underwent PEA surgery. This is the largest series of patients with pre- and post-PEA MRI assessment so far reported. MRI detects changes in parameters reflecting cardiac remodeling and pulmonary clearance, but measurements are significantly different from those of RHC.
Multimedia Manual of Cardio-Thoracic Surgery, 2009
The treatment of choice for patients with chronic thromboembolic pulmonary hypertension is pulmon... more The treatment of choice for patients with chronic thromboembolic pulmonary hypertension is pulmonary endarterectomy to reduce pulmonary vascular resistance with significant symptomatic and prognostic benefit. The fundamental aim of the surgery is to perform a full endarterectomy (not embolectomy or thrombectomy) in both pulmonary arteries. The operation is performed via a median sternotomy with hypothermic cardiopulmonary bypass (CPB) at 20 8C. Pulmonary arteriotomies are performed within the pericardium and periods of circulatory arrest are necessary to reduce collateral blood flow from bronchial arteries and allow a clear field for dissection distally. The endarterectomy plane is raised carefully as it is essential the correct layer be identified. The dissection proceeds within the superficial media into all the affected segmental and sub-segmental vessels. A cast of the inner layer of the pulmonary arterial tree is then dissected free by eversion moving towards the periphery. After completion of the endarterectomies, and the patient is rewarmed slowly on full CPB. During weaning from CPB the right-sided filling pressures should be kept low, guided by invasive haemodynamic monitoring. Survival to hospital discharge is )95% in experienced centres with outcome dependent on the disease pattern and pulmonary vascular resistance pre-and post-surgery.
Clinical sarcoma research, 2015
Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy that leads to heart failure an... more Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy that leads to heart failure and death without treatment. Here we reviewed the presentation and management of patients treated at a national centre for pulmonary endarterectomy (PEA) and its associated hospital in Cambridge, UK. Details of PAS patients treated at Papworth and Addenbrooke's Hospitals between 2000 and 2014 were reviewed. Twenty patients were diagnosed with PAS (11 males, 9 females), with a median age of presentation of 57 years (range 27-77). Presenting symptoms include dyspnoea (20), chest pain/tightness (7), oedema (5), constitutional symptoms (5), cough (3) and haemoptysis (3). Twelve patients were in group III/IV of the NYHA functional classification of symptoms. Initial CT scans were suggestive of thromboembolism in seven patients. Histological findings were of intimal sarcoma (13) and high grade sarcoma NOS (6). Median overall survival (OS) was 17 months. Fourteen patients underwent PEA to rel...
International Journal of Molecular Medicine, 2010
Congestive heart failure, a complex disease of heterogeneous etiology, involves alterations in th... more Congestive heart failure, a complex disease of heterogeneous etiology, involves alterations in the expression of multiple genes. The Popeye domain-containing (POPDC) family of three novel muscle-restricted genes (POPDC1-3) is evolutionarily conserved and developmentally regulated. In mice, POPDC1 has been shown to play an important role in skeletal and cardiac muscles subjected to injury or stress. However, it has never been explored in human hearts. In biopsies from non-failing and failing human hearts, we examined the cellular distribution of POPDC1 as well as the expression patterns of POPDC1-3 mRNAs. POPDC1 was visualized by immunohistochemistry and estimated by Western immunoblotting. The mRNA levels of POPDC1-3 and ß myosin heavy chain (MYHC7) were assessed using reverse transcription/quantitative polymerase chain reaction. POPDC1 was predominantly localized in the sarcolemma with an enhanced expression in the intercalated discs. In failing hearts, many cardiomyocytes appeared deformed and POPDC1 labeling was deranged. The three POPDC mRNAs were expressed in the four heart chambers with higher transcript levels in the ventricles compared to the atria. Heart failure concurred with reduced levels of POPDC1 mRNA and protein in the left ventricle. Correlation analyses of mRNA levels among the failing heart specimens indicated the coordinated regulation of POPDC1 with POPDC3 and of POPDC2 with MYHC7. It can be concluded that POPDC gene expression is modified in end-stage heart failure in humans in a manner suggesting regulatory and/or functional differences between the three family members and that POPDC1 is particularly susceptible to this condition.
Transplantation, 2004
The availability of organ transplants depends largely on the will of the donor families. Given th... more The availability of organ transplants depends largely on the will of the donor families. Given the current state of affairs in Israel, the authors evaluated the stance of Jews and Arabs toward mutual organ donations. Between October 1997 and December 1999, there were 4.8 million Jews and 1.09 million Arabs living in Israel. Data gathered from 22 general hospitals for this period yielded 373 potential organ donors and 171 families (45.8%) that consented to the procedure. Actual donation was obtained from 157 patients. The authors examined the characteristics of the potential organ donors and organ recipients and the reasons (religious and nonreligious) for familial consent or refusal. Donation made since onset of the Intifada (armed Palestinian resistance) was also reviewed to determine whether any changes took place. Consent was obtained from 48.9% of the Jewish families approached, 30.7% of the Muslim Arabs, and 66.6% of the Christian Arabs. For the whole sample, altruism was the main reason for consenting. The percentages of Arabs and Jews (per population) on the waiting list for a heart (Jews, 90%; Arabs, 10%) or liver (Jews, 78.66%; Arabs, 21.34%) and who received a heart (Jews, 90%; Arabs, 10%) or liver (Jews, 78.36%; Arabs, 21.64%) were similar. There were relatively more Arab recipients of kidney transplants (waiting list, 11%; recipients, 18.6%) because of the higher percentage of children in the Arab group who were given priority. Since September 2000 (start of the Intifada), there has been a trend toward an increasing rate of refusal to donate among Arabs (consent obtained in 52.9% of Jewish families approached vs. 27.9% of the Muslim Arabs), mainly because of fear of rejection by the community for cooperating with Jews. The rate of organ donations among Arabs and Jews in Israel is proportional to their representation in the general population. The main reason for donating organs is altruism. Apparently, altruism cuts across the boundaries of religion and ethnic groups, even in a country where conflict prevails. We trust that progress in the international arena will bring the current cycle of violence to an end and allow humanitarian values to take preference over politics.
The Journal of Thoracic and Cardiovascular Surgery, 2011
Objective: Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmona... more Objective: Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. In many patients hemodynamics are normalized early after surgical intervention. However, the effect of residual pulmonary hypertension on postoperative clinical status and survival is unknown.
Journal of Molecular and Cellular Cardiology, 2008
The Annals of Thoracic Surgery, 2007
We describe a case of takotsubo cardiomyopathy in a 69-year-old woman after right upper lobectomy... more We describe a case of takotsubo cardiomyopathy in a 69-year-old woman after right upper lobectomy, without cardiac antecedents. The immediate course of recovery was uneventful. On the first postoperative day, clinical symptoms of acute coronary syndrome developed in association with ischemic electrocardiographic changes and a mild elevation in creatinine phosphokinase levels. Echocardiography showed moderate left ventricular dysfunction, with a typical takotsubo pattern. Coronary angiography revealed no abnormalities. After 2 days of supportive treatment, the patient recovered completely. The clinical presentation, instrumental findings, additional cardiac and noncardiac diseases, and the potential pathomechanism of takotsubo cardiomyopathy are described according to the current medical literature.
Transplantation, Feb 1, 2004
The availability of organ transplants depends largely on the will of the donor families. Given th... more The availability of organ transplants depends largely on the will of the donor families. Given the current state of affairs in Israel, the authors evaluated the stance of Jews and Arabs toward mutual organ donations. Between October 1997 and December 1999, there were 4.8 million Jews and 1.09 million Arabs living in Israel. Data gathered from 22 general hospitals for this period yielded 373 potential organ donors and 171 families (45.8%) that consented to the procedure. Actual donation was obtained from 157 patients. The authors examined the characteristics of the potential organ donors and organ recipients and the reasons (religious and nonreligious) for familial consent or refusal. Donation made since onset of the Intifada (armed Palestinian resistance) was also reviewed to determine whether any changes took place. Consent was obtained from 48.9% of the Jewish families approached, 30.7% of the Muslim Arabs, and 66.6% of the Christian Arabs. For the whole sample, altruism was the main reason for consenting. The percentages of Arabs and Jews (per population) on the waiting list for a heart (Jews, 90%; Arabs, 10%) or liver (Jews, 78.66%; Arabs, 21.34%) and who received a heart (Jews, 90%; Arabs, 10%) or liver (Jews, 78.36%; Arabs, 21.64%) were similar. There were relatively more Arab recipients of kidney transplants (waiting list, 11%; recipients, 18.6%) because of the higher percentage of children in the Arab group who were given priority. Since September 2000 (start of the Intifada), there has been a trend toward an increasing rate of refusal to donate among Arabs (consent obtained in 52.9% of Jewish families approached vs. 27.9% of the Muslim Arabs), mainly because of fear of rejection by the community for cooperating with Jews. The rate of organ donations among Arabs and Jews in Israel is proportional to their representation in the general population. The main reason for donating organs is altruism. Apparently, altruism cuts across the boundaries of religion and ethnic groups, even in a country where conflict prevails. We trust that progress in the international arena will bring the current cycle of violence to an end and allow humanitarian values to take preference over politics.
American Journal of Physiology Heart and Circulatory Physiology, Apr 1, 1991
Page 1. Estimated time course of Ca2+ bound to troponin C during relaxation in isolated cardiac m... more Page 1. Estimated time course of Ca2+ bound to troponin C during relaxation in isolated cardiac muscle JON N. PETERSON, WILLIAM C. HUNTER, AND MICHAEL R. BERMAN Department of Biomedical Engineering, The Johns ...
The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 mo... more The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 months, range 6 - 18 months) and value of transaxillary single-port thoracic sympathectomy using a thoracoscope with an operating channel for the treatment of hyperhidrosis. Between December 1992 and October 2002, 176 consecutive patients (94 men, 82 women, mean age 21 years) with hyperhidrosis underwent
J Heart Lung Transplant, 2008
http://ats.ctsnetjournals.org/cgi/content/full/76/2/601 located on the World Wide Web at:
Anesthesia and analgesia, Jan 27, 2015
Administration of coagulation factor concentrates to treat bleeding after cardiac surgery with ca... more Administration of coagulation factor concentrates to treat bleeding after cardiac surgery with cardiopulmonary bypass might be a strategy for reducing allogeneic blood transfusions, particularly for patients treated with warfarin preoperatively. We performed an exploratory analysis on whether the use of prothrombin complex concentrate (PCC) is safe and effective compared with fresh frozen plasma (FFP) to treat coagulopathy after pulmonary endarterectomy surgery with deep hypothermic circulatory arrest. Consecutive adult patients who underwent pulmonary endarterectomy surgery between January 2010 and September 2012 and received PCC or FFP to treat coagulopathy were studied. Blood loss during the first 12 hours of admission to the intensive care unit and patient outcomes were compared with propensity score adjustment. Three hundred fifty-one patients underwent pulmonary endarterectomy surgery, all of whom had warfarin discontinued for up to 5 days before surgery; bleeding complication...
BACKGROUND: Pulmonary thromboendarterectomy (PTE) is the treatment of choice for patients with ch... more BACKGROUND: Pulmonary thromboendarterectomy (PTE) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension. However, some patients develop severe cardiorespiratory compromise soon after separating from ...
The Journal of heart valve disease, 2005
Papillary fibroelastoma (PFE) is a rare and histologically benign tumor, but it may have malignan... more Papillary fibroelastoma (PFE) is a rare and histologically benign tumor, but it may have malignant propensity for life-threatening complications. Herein are described four cases of PFE which reflect the clinical diversity of this lesion. The diagnostic and surgical approach utilized is also briefly reviewed. The files of four patients with cardiac valvular PFE treated at the authors' center between January 2002 and November 2003 were reviewed. The diagnosis was strongly suggested by echocardiography. Tumors were noted in aortic (n = 2), mitral (n = 1) and tricuspid (n = 1) sites. Indications for surgery were myocardial infarction (both aortic tumors), previous stroke (mitral tumor), and preventive (tricuspid tumor). Surgical excision with a conservative, valve-sparing approach was performed in all cases. For the first aortic tumor, the aortic valve was reconstructed with a patch of autologous pericardium. None of the patients had evidence of valvular regurgitation after excision...
Interactive cardiovascular and thoracic surgery, 2004
The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 mo... more The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 months, range 6-18 months) and value of transaxillary single-port thoracic sympathectomy using a thoracoscope with an operating channel for the treatment of hyperhidrosis. Between December 1992 and October 2002, 176 consecutive patients (94 men, 82 women, mean age 21 years) with hyperhidrosis underwent thoracoscopic sympathectomy via a 12-mm single-port approach. Data on postoperative morbidity and outcome were analyzed to validate the technique. Mean operative time per side was 9 min; there was no conversion to an open procedure. Ninety-five percent of the patients were discharged the next day. Thirty-day mortality was zero. Complications included unilateral transient Horner's syndrome (n=1), residual pneumothorax requiring chest drainage from the port entry (n=4), and segmental atelectasis of the lung (n=4) which was treated conservatively. Complete relief of symptoms was observed in...
Interactive cardiovascular and thoracic surgery, 2005
Prior studies have suggested that inflammation and possibly bacterial infections play a role in a... more Prior studies have suggested that inflammation and possibly bacterial infections play a role in atherogenesis and in the clinical pathogenesis of cardiovascular diseases. Treatment with the macrolide antibiotics has been associated with improved outcome from cardiovascular disease, although the mechanism through which they exert their effects may be unrelated to their antibiotic properties. Drugs that exert a vasodilator effect on arteries have been associated with attenuated atherogenesis and improved outcome from cardiovascular disease. To determine the effect of the macrolide, roxithromycin (RX), on arterial vasoactivity. Human internal mammary artery (IMA) and rat thoracic aorta (TA) rings were placed in organ chambers and contracted with norepinephrine (NE). Endothelial and smooth muscle integrity were assessed using acetylcholine (ACh) and nitroprusside (SNP), respectively. After restabilization, the rings were exposed to 10(-6) M NE, followed by increasing concentrations of R...
The Annals of thoracic surgery, 2011
Untreated severe chronic thromboembolic pulmonary hypertension has a poor prognosis ending with r... more Untreated severe chronic thromboembolic pulmonary hypertension has a poor prognosis ending with right heart decompensation and multiorgan failure. This case report demonstrates that it is possible to intervene in the terminal stages of chronic thromboembolic pulmonary hypertension and bridge patients to surgery and recovery using various forms of extracorporeal membrane oxygenation support.
The European respiratory journal, 2014
Chronic thromboembolic disease is characterised by persistent pulmonary thromboembolic occlusions... more Chronic thromboembolic disease is characterised by persistent pulmonary thromboembolic occlusions without pulmonary hypertension. Early surgical treatment with pulmonary endarterectomy may improve symptoms and prevent disease progression. We sought to assess the outcome of pulmonary endarterectomy in symptomatic patients with chronic thromboembolic disease. Patients with symptomatic chronic thromboembolic disease and a mean pulmonary artery pressure <25 mmHg at baseline with right heart catheterisation and treated with pulmonary endarterectomy between January 2000 and July 2013 were identified. Patients were reassessed at 6 months and at 1 year following surgery. A total of 42 patients underwent surgery and the median length of stay in hospital was 11 days. There was no in-hospital mortality but complications occurred in 40% of patients. At 1 year, following surgery, 95% of the patients remained alive. There was a significant symptomatic improvement with 95% of patients in the Ne...
Pulmonary Circulation, 2014
The objective of this study was to assess the effect of pulmonary endarterectomy (PEA) on right v... more The objective of this study was to assess the effect of pulmonary endarterectomy (PEA) on right ventricular (RV) reverse remodeling using magnetic resonance imaging (MRI) and to correlate MRI findings with clinical and hemodynamic outcomes postsurgery. We performed a retrospective analysis in 72 patients undergoing PEA surgery in whom MRI and right heart catheterization (RHC) were performed preoperation and 3 months postoperation. RV volumes and mass were assessed by MRI. Continuous variables were expressed as means, changes were compared with a paired t test, and associations between the variables were explored using Pearson correlation coefficients. The mean age was 57 years, and 51% were male. Both RV end-diastolic volume (EDV; 176-117 mL; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and RV end-systolic volume (ESV; 129-64 mL; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) reduced significantly following PEA. Preoperative pulmonary artery pressure (PAP) correlated moderately with ESV (r = 0.46, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Postoperatively, PAP correlated with EDV (r = 0.45, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and ESV (r = 0.44, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Moderate correlation was present between hemodynamic parameters: PAP, pulmonary vascular resistance, and right atrial pressure with pre- and postoperation end-systolic and end-diastolic RV mass (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). RHC and MRI measurements of cardiac output and RV volumes were significantly different (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In conclusion, RV reverse remodeling, as measured by improvement in RV volumes and mass by MRI, was observed for 3 months in patients who underwent PEA surgery. This is the largest series of patients with pre- and post-PEA MRI assessment so far reported. MRI detects changes in parameters reflecting cardiac remodeling and pulmonary clearance, but measurements are significantly different from those of RHC.
Multimedia Manual of Cardio-Thoracic Surgery, 2009
The treatment of choice for patients with chronic thromboembolic pulmonary hypertension is pulmon... more The treatment of choice for patients with chronic thromboembolic pulmonary hypertension is pulmonary endarterectomy to reduce pulmonary vascular resistance with significant symptomatic and prognostic benefit. The fundamental aim of the surgery is to perform a full endarterectomy (not embolectomy or thrombectomy) in both pulmonary arteries. The operation is performed via a median sternotomy with hypothermic cardiopulmonary bypass (CPB) at 20 8C. Pulmonary arteriotomies are performed within the pericardium and periods of circulatory arrest are necessary to reduce collateral blood flow from bronchial arteries and allow a clear field for dissection distally. The endarterectomy plane is raised carefully as it is essential the correct layer be identified. The dissection proceeds within the superficial media into all the affected segmental and sub-segmental vessels. A cast of the inner layer of the pulmonary arterial tree is then dissected free by eversion moving towards the periphery. After completion of the endarterectomies, and the patient is rewarmed slowly on full CPB. During weaning from CPB the right-sided filling pressures should be kept low, guided by invasive haemodynamic monitoring. Survival to hospital discharge is )95% in experienced centres with outcome dependent on the disease pattern and pulmonary vascular resistance pre-and post-surgery.
Clinical sarcoma research, 2015
Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy that leads to heart failure an... more Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy that leads to heart failure and death without treatment. Here we reviewed the presentation and management of patients treated at a national centre for pulmonary endarterectomy (PEA) and its associated hospital in Cambridge, UK. Details of PAS patients treated at Papworth and Addenbrooke's Hospitals between 2000 and 2014 were reviewed. Twenty patients were diagnosed with PAS (11 males, 9 females), with a median age of presentation of 57 years (range 27-77). Presenting symptoms include dyspnoea (20), chest pain/tightness (7), oedema (5), constitutional symptoms (5), cough (3) and haemoptysis (3). Twelve patients were in group III/IV of the NYHA functional classification of symptoms. Initial CT scans were suggestive of thromboembolism in seven patients. Histological findings were of intimal sarcoma (13) and high grade sarcoma NOS (6). Median overall survival (OS) was 17 months. Fourteen patients underwent PEA to rel...
International Journal of Molecular Medicine, 2010
Congestive heart failure, a complex disease of heterogeneous etiology, involves alterations in th... more Congestive heart failure, a complex disease of heterogeneous etiology, involves alterations in the expression of multiple genes. The Popeye domain-containing (POPDC) family of three novel muscle-restricted genes (POPDC1-3) is evolutionarily conserved and developmentally regulated. In mice, POPDC1 has been shown to play an important role in skeletal and cardiac muscles subjected to injury or stress. However, it has never been explored in human hearts. In biopsies from non-failing and failing human hearts, we examined the cellular distribution of POPDC1 as well as the expression patterns of POPDC1-3 mRNAs. POPDC1 was visualized by immunohistochemistry and estimated by Western immunoblotting. The mRNA levels of POPDC1-3 and ß myosin heavy chain (MYHC7) were assessed using reverse transcription/quantitative polymerase chain reaction. POPDC1 was predominantly localized in the sarcolemma with an enhanced expression in the intercalated discs. In failing hearts, many cardiomyocytes appeared deformed and POPDC1 labeling was deranged. The three POPDC mRNAs were expressed in the four heart chambers with higher transcript levels in the ventricles compared to the atria. Heart failure concurred with reduced levels of POPDC1 mRNA and protein in the left ventricle. Correlation analyses of mRNA levels among the failing heart specimens indicated the coordinated regulation of POPDC1 with POPDC3 and of POPDC2 with MYHC7. It can be concluded that POPDC gene expression is modified in end-stage heart failure in humans in a manner suggesting regulatory and/or functional differences between the three family members and that POPDC1 is particularly susceptible to this condition.
Transplantation, 2004
The availability of organ transplants depends largely on the will of the donor families. Given th... more The availability of organ transplants depends largely on the will of the donor families. Given the current state of affairs in Israel, the authors evaluated the stance of Jews and Arabs toward mutual organ donations. Between October 1997 and December 1999, there were 4.8 million Jews and 1.09 million Arabs living in Israel. Data gathered from 22 general hospitals for this period yielded 373 potential organ donors and 171 families (45.8%) that consented to the procedure. Actual donation was obtained from 157 patients. The authors examined the characteristics of the potential organ donors and organ recipients and the reasons (religious and nonreligious) for familial consent or refusal. Donation made since onset of the Intifada (armed Palestinian resistance) was also reviewed to determine whether any changes took place. Consent was obtained from 48.9% of the Jewish families approached, 30.7% of the Muslim Arabs, and 66.6% of the Christian Arabs. For the whole sample, altruism was the main reason for consenting. The percentages of Arabs and Jews (per population) on the waiting list for a heart (Jews, 90%; Arabs, 10%) or liver (Jews, 78.66%; Arabs, 21.34%) and who received a heart (Jews, 90%; Arabs, 10%) or liver (Jews, 78.36%; Arabs, 21.64%) were similar. There were relatively more Arab recipients of kidney transplants (waiting list, 11%; recipients, 18.6%) because of the higher percentage of children in the Arab group who were given priority. Since September 2000 (start of the Intifada), there has been a trend toward an increasing rate of refusal to donate among Arabs (consent obtained in 52.9% of Jewish families approached vs. 27.9% of the Muslim Arabs), mainly because of fear of rejection by the community for cooperating with Jews. The rate of organ donations among Arabs and Jews in Israel is proportional to their representation in the general population. The main reason for donating organs is altruism. Apparently, altruism cuts across the boundaries of religion and ethnic groups, even in a country where conflict prevails. We trust that progress in the international arena will bring the current cycle of violence to an end and allow humanitarian values to take preference over politics.
The Journal of Thoracic and Cardiovascular Surgery, 2011
Objective: Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmona... more Objective: Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. In many patients hemodynamics are normalized early after surgical intervention. However, the effect of residual pulmonary hypertension on postoperative clinical status and survival is unknown.
Journal of Molecular and Cellular Cardiology, 2008