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1.  Minimally-Invasive Fibrillating Mitral Valve Replacement for Patients with Advanced Cardiomyopathy: a Safe and Effective Approach to Treat a Complex Problem 
The optimal management of mitral regurgitation (MR) in patients with cardiomyopathy is controversial. Mini-MVR may limit post-operative morbidity and mortality by minimizing recurrent MR. We hypothesized that minimally-invasive fibrillating mitral valve replacement (mini-MVR) with complete chordal sparing would offer a low mortality and halt left ventricular (LV) remodeling in patients with severe cardiomyopathy and severe MR.
Methods and Results
Between 1/06 - 8/09, 65 patients with LVEF ≤ 35% underwent mini-MVR. Demographic, echocardiographic, and clinical outcomes were analyzed.
Operative mortality compared to Society for Thoracic Surgery (STS)-predicted mortality was 6.2 versus 6.6%; 5.6 versus 7.4% among patients with LVEF ≤ 20%; and 8.3 versus 17.9% among patients with STS-predicted mortality of ≥ 10%. At median follow-up of 17 months there was no recurrent MR or change in LV dimensions or LVEF, but there was a decrease (p = 0.02) in right ventricular systolic pressure (RVSP). At the first post-operative visit and longest follow-up, NYHA class decreased from 3.0 ± 0.6 to 1.7 ± 0.7 and 2.0 ± 1.0, respectively (both p < 0.0001). Patients with LVEF ≤ 20% and LVEDD ≥ 6.5cm were more likely to meet a composite of death, transplant, or LV assist device insertion (p = 0.046).
Mini-MVR is safe in advanced cardiomyopathy, and resulted in no recurrent MR, stabilization of LVEF and LV dimensions, and a decrease in RVSP. This mini-MVR fibrillating technique can be used to address severe MR in patients with advanced cardiomyopathy.
PMCID: PMC4050032  PMID: 24332110
Mitral valve; surgery; cardiomyopathy; echocardiography
2.  Maximum carotid artery wall thickness and risk factors in a young primary prevention population 
Brain and Behavior  2012;2(5):590-594.
Maximum carotid artery wall thickness was utilized in a primary prevention population and compared with baseline risk factors. Carotid wall thickness was measured between the blood–intima and media–adventitia interfaces by B-mode ultrasonography using software calipers at points of protrusion. Long-axis measures were confirmed by short-axis assessment. The maximum carotid wall thickness for each subject was divided by age in years to yield an annual accretion rate (called carotid intima–media thickness accretion rate [CIMTAR]). The entire study population was then divided by median CIMTAR to investigate the association with baseline variables used in standard risk assessments with the bifurcated groups. Traditional risk factors such as age, diabetes, smoking, hyperlipidemia, and obesity were not associated with greater than median CIMTAR. Only male gender (P = 0.02) and systolic blood pressure (P = 0.002) in baseline variables were associated with an elevated CIMTAR for the entire population. Among those not taking lipid-lowering therapy at baseline, only systolic blood pressure remained significant (P = 0.0002). Correlations between low-density lipoprotein (LDL) cholesterol level and maximum carotid wall thickness/CIMTAR were weak for the entire population (r = −0.17/r = −0.12, respectively). Measure of maximum carotid wall thickness may select patients earlier for treatment than traditional risk factors. The addition of CIMTAR to risk algorithms may permit a single-point assignation of subsequent vascular risk that is more efficacious than traditional risk factors.
PMCID: PMC3489811  PMID: 23139904
Atherogenesis; carotid wall thickness; IMT; stroke
3.  Unmasking of Brugada Syndrome by Lithium 
Circulation  2005;112(11):1527-1531.
The characteristic ECG pattern of ST-segment elevation in V1 and V2 in the Brugada syndrome is dynamic; it is often intermittently present in affected individuals and can be unmasked by sodium channel blockers, including antiarrhythmic drugs and tricyclic antidepressants. We report here 2 patients who developed the Brugada ECG pattern after administration of lithium, a commonly used drug not previously reported to block cardiac sodium channels.
Methods and Results
Lithium induced transient ST-segment elevation (type 1 Brugada pattern) in right precordial leads at therapeutic concentrations in 2 patients with bipolar disorder. Lithium withdrawal in the patients resulted in reversion to type 2 or 3 Brugada patterns or resolution of ST-T abnormalities. In Chinese hamster ovary cells transfected with SCN5A, which encodes the cardiac sodium channel, lithium chloride caused concentration-dependent block of peak INa at levels well below the therapeutic range (IC50 of 6.8±0.4 μmol/L).
The widely used drug lithium is a potent blocker of cardiac sodium channels and may unmask patients with the Brugada syndrome.
PMCID: PMC1350464  PMID: 16144991
Brugada syndrome; lithium; drugs; genetics; ion channels

Results 1-3 (3)