About five years ago, Craig Wilkins was feeling tired and breathless and decided to see his family doctor in Cary, N.C., before going on a trip.
Craig was otherwise healthy and had no history of heart disease, but his doctor discovered he had atrial fibrillation, a condition that can cause the heart to race, sometimes beating hundreds of times in one minute. For some, atrial fibrillation is annoying but not life-threatening. For Craig, the condition had gone undetected for so long that he had developed congestive heart failure.
After several attempts to regulate the heartbeat with cardioversion and with anti-arrhythmia medication, Craig's heart was still falling out of rhythm. His cardiologist referred him to Paul Mounsey, MD, director of electrophysiology at UNC Hospitals. Dr. Mounsey performed a cardiac ablation on Craig’s heart. In an ablation, doctors use radiofrequency to destroy the damaged heart tissue causing the atrial fibrillation. Ablations are often successful, but in Craig’s case, they were not. Dr. Mounsey then collaborated with Andy Kiser, M.D., chief of the UNC Division of Cardiothoracic Surgery, to perform the Convergent Procedure.
Traditionally, surgeons such as Dr. Kiser have created scar patterns to disrupt the circuitry that causes atrial fibrillation arrhythmia, while electrophysiologists such as Dr. Mounsey have performed ablations. In the Convergent Procedure, developed by Dr. Kiser, an electrophysiologist and surgeon work together using miniature cameras, small catheters and electrodes to map out an individualized pattern that will work to reestablish normal rhythms in each patient.
Drs. Kiser and Mounsey have completed procedures on more than 100 patients since 2011. They have an 80 percent success rate, very high for complex arrhythmias.
Five years after Craig’s initial atrial fibrillation diagnosis and a year and a half after having the Convergent Procedure, he says his health is excellent. “I can’t believe how bad I used to feel,” says Craig. “I have energy and a desire to do things now.”
Read more here, in a story by Stephanie Soucheray-Grell from UNC Health Care's magazine, Well.
Residents and medical students at UNC are invited to submit abstracts for the annual meeting of the Nathan A. Womack Surgical Society, to be held at the University of North Carolina at Chapel Hill from May 1 to 3, 2014. Abstract submissions will be accepted until Friday, April 4, 2014, at 11 p.m. EDT. Four submitted abstracts will be selected for presentation at the annual meeting on Friday, May 2. The George F. Sheldon Research Competition Award will be given for the most outstanding presentation. Abstracts may be on any medical research topic but are often related to surgery.
Please follow these instructions to submit an abstract:
Abstract Limit: There are no restrictions on the number of abstracts you may submit.
Character Limit: There is a limit of 250 words for the text of your abstract submission. Title, authors, institutions, tables, and images are not counted in the 250-word limit.
Tables and Images: You may add 1 table and 1 image to your submission.
Abstract Structure: All abstracts must be structured with the following headings and content:
- Objectives – A brief statement on the objectives of the study and the current state of research in the field. What limitation or problem does this study address?
- Methods – The methods of study or experimental approach must be defined briefly.
- Results – A summary of the study results, including sufficient details to support those conclusions. A brief table or image may be used.
- Conclusions – A statement concerning the significance of the work and its implications for further research or clinical practice.
George F. Sheldon Research Competition Award
The award is named after the late George F. Sheldon, M.D., Zach D. Owens Distinguished Professor of Surgery. Dr. Sheldon chaired the UNC Department of Surgery from 1984 to 2001 and served as president of the American College of Surgeons from 1998 to 1999. This award will be awarded to the medical student or resident in training with the most outstanding presentation. Selection will be based upon the quality of abstract as well as the oral presentation, as judged by a panel of visitors and UNC faculty. The award includes $500 cash and recognition at the annual Womack Society reception on Friday evening, May 2.
Submission: All abstracts must be submitted electronically to Andy Kiser, M.D., firstname.lastname@example.org , by 11 p.m. EDT on April 4, 2014. Questions may be directed to Dr. Kiser or to Debbie Alberti, email@example.com , at (919) 966-3391.
Read about the Nathan A. Womack Surgical Society here.
Dr. Feins joins with Dr. Alterovitz on project to develop robotic tentacle device that reaches far into lungs or head
Ron Alterovitz, PhD, assistant professor of computer science and head of the Computational Robotics Research Group in the UNC Department of Computer Science, has been investigating new algorithms that can enable robotic tentacles to achieve depth and precision inside the human body.
He has focused on a new surgical device – a robotic set of concentric nested tubes made of nickel titanium. The device can be deployed from the tip of a bronchoscope, allowing physicians to reach farther than ever into the lungs to diagnose abnormal growths. It can also be deployed via the nose to surgically access tumors in the brain or nearby structures in the head. The robotic device has the potential to move through the body so precisely that it can avoid anatomical obstacles and reach its target within a millimeter. Richard H. Feins, MD, of the UNC Division of Cardiothoracic Surgery, has been working with Dr. Alterovitz on the project. Brent Senior, MD, Nathaniel and Sheila Harris Distinguished Professor of Otolaryngology, is interested in Dr. Alterovitz's research for its potential to reach tiny areas of the head.
Read more about their collaboration here, in an article by Zach Read of the UNC Health Care News Team.
Courtney, a 17-year-old cardiac patient, has been cared for by UNC doctors since she was a baby. She has been treated medically and surgically for her heart problems. Most recently, Michael R. Mill, M.D., repaired her mitral valve in June 2013 and Jennifer S. Nelson, M.D., implanted a left ventricular assist device (LVAD) when Courtney's heart was failing in August 2013. The LVAD, which is not often implanted in pediatric patients, will support her heart until she can receive a heart transplant.
Courtney's courage has impressed her doctors.
“The evening of her [LVAD] surgery, she woke up calmly, her breathing tube in place, and asked for a pen and paper,” Dr. Nelson said. “On that paper, the first thing she wrote was, 'Thank you. Courtney'. I still have a picture of that note. Every time I look at it, I am blown away by her bravery.”
Michael R. Mill, M.D., a professor of surgery in the UNC Division of Cardiothoracic Surgery, has been appointed professor of pediatrics in the Department of Pediatrics at UNC, effective Dec. 20, 2013. Under the joint appointment, Dr. Mill will teach and do research with the Department of Pediatrics, focusing on congenital cardiac surgery.
Dr. Mill, director of pediatric cardiac surgery at UNC, joined the UNC Division of Cardiothoracic Surgery in 1988 and served as chief of the division for 12 years. He started the heart transplant program at UNC and performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina. He has served as director of the UNC Comprehensive Transplant Center and as program director of the UNC Cardiothoracic Surgery Residency Program, and has been active in national organizations relating to cardiothoracic surgery and residency training. He recently served as co-investigator on a study funded by the Agency for Healthcare Research and Quality, Improving patient safety in a pediatric service line (grant 05-R18 H5019636-01-02). His clinical interests include neonatal and pediatric heart surgery, pediatric and adult heart and heart-lung transplantation, complex valve repairs, mechanical cardiac assist devices, and surgery for end-stage heart failure. He is listed in the U.S. News and World Report's "Top Doctors" database and in the "Best Doctors in America" database.
Congratulations to Drs. Thomas M. Egan and Michael R. Mill, who are both listed in the 2014 "Best Doctors in America" database. "Best Doctors" lists outstanding physicians who have been nominated for inclusion by their peers. Dr. Egan and Dr. Mill, both professors of surgery in the UNC Division of Cardiothoracic Surgery, are among 251 doctors at UNC.
Dr. Egan, a thoracic surgeon, is internationally known for his research on lung transplantation. He joined the UNC faculty in 1989 and began its lung transplant program. He is principal investigator of a large, NIH-funded clinical trial to study assessment and transplantation of lungs from victims of sudden death (More and Better Lungs: Ex-Vivo Perfusion of Lungs from Non-Heart-Beating Donors, grant 1 UM1 HL113115-01A1). Dr. Egan has shown that lungs are still viable after circulation stops because lung cells obtain oxygen after death from air in the air sacs and airways (other organs require blood circulation to obtain oxygen). If successful, his project could greatly increase the number of lungs available for transplant. He led the group that developed a 2005 change in U.S. allocation policy for lung transplants that allocates donor lungs based primarily on estimates of survival probability; this change has been credited with saving lives and improving efficiency. He no longer performs surgery due to a physical disability but is available for second opinions or consultation.
Dr. Mill, a congenital cardiac surgeon, is director of pediatric cardiac surgery at UNC and started the heart transplant program at UNC after his arrival in 1988. He performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina. He has served as chief of the Division of Cardiothoracic Surgery at UNC, director of the UNC Comprehensive Transplant Center, and program director of the UNC Cardiothoracic Surgery Residency Program, which trains future surgeons. He has studied clinical outcomes of transplantation and also pulmonary blood flow physiology in congenital heart disease. He has recently been co-investigator on a study funded by the Agency for Healthcare Research and Quality, Improving patient safety in a pediatric service line (grant 05-R18 H5019636-01-02). His clinical interests include neonatal and pediatric heart surgery, pediatric and adult heart and heart-lung transplantation, complex valve repairs, mechanical cardiac assist devices, and surgery for end-stage heart failure.
- Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery, firstname.lastname@example.org
A clinical trial underway at the University of North Carolina is testing the idea that lungs can be recovered for transplant from people who die suddenly, away from the hospital. Lungs for transplant normally come from people who have suffered brain death and have been on a ventilator in a hospital, but many lungs from these donors are not usable because of infection or inflammation resulting from brain injury. Many people with end-stage lung disease are unable to get lung transplants because of the serious shortage of suitable lungs.
Thomas M. Egan, M.D., is principal investigator of the UNC study, which is funded by the National Institutes of Health/National Heart, Lung, and Blood Institute (NHLBI grant 1 UM1 HL113115-01A1). UNC co-investigators include Benjamin Haithcock, M.D., and Jason Long, M.D., of the UNC Division of Cardiothoracic Surgery; Peadar Noone, M.D., of the UNC Division of Pulmonary Diseases and Critical Care Medicine; of the UNC Department of Biostatistics and , Ph.D.,Katherine Birchard, M.D., of the UNC Department of Radiology.
The Associated Press reported on the study in a story on Nov. 17, 2013. Read the AP article here and watch an AP video about the study .
Dr. Egan pioneered the idea that lungs could be suitable for transplant for hours after circulation stops because lung cells obtain oxygen after death from air sacs and airways (other organs require blood circulation to obtain oxygen). He believes that the lungs from people who have died suddenly may not only be plentiful; they may be superior to lungs transplanted from brain-dead donors.
The study uses lungs from people in Wake County, NC, who have indicated that they wish to be organ donors and who have died of sudden cardiac arrest, usually at home. If emergency crews fail to resuscitate the person, organ donation officials talk to family members to request use of the lungs for possible transplant. If the family agrees, the body is transported to UNC Hospitals, where the lungs are recovered and assessed for transplant using ex-vivo (outside the body) perfusion. Lungs that are found acceptable will be transplanted to patients who have consented to use of the lungs under protocols approved by the Food and Drug Administration (FDA) and the UNC Institutional Review Board (IRB). Outcomes will be compared to patients who have received transplanted lungs from conventional donors. No other research team in the United States has FDA approval to test transplants of lungs from sudden-death donors.
Wake County Emergency Medical Services, law enforcement, the North Carolina medical examiner's office, and other government offices are cooperating in the project.
Contact: Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery, email@example.com
Jennifer S. Nelson, M.D., joined the UNC Division of Cardiothoracic Surgery in August as a pediatric cardiac surgeon. She serves as an assistant professor of surgery in the UNC School of Medicine and as director of the Congenital ECMO Program at the North Carolina Children’s Hospital.
Dr. Nelson earned B.S. (with Distinction) and M.D. degrees from the University of North Carolina at Chapel Hill and finished a General Surgery residency at UNC in 2010. She completed a Thoracic Surgery residency at the University of Michigan in 2012 and was an ACGME Fellow in congenital cardiac surgery at Michigan in 2012-13.
Her clinical interests include pediatric heart surgery, heart surgery in newborns and low birth weight infants, adult congenital heart surgery, and ECMO (extracorporeal membrane oxygenation).
Her research interests include the Ross procedure in children, post-cardiotomy ECMO, and pediatric cardiac assist devices.
To make an appointment with Dr. Nelson, call 919-966-3382.
Dr. Long earned a B.S. from the University of North Carolina at Chapel Hill, an M.P.H. from Harvard University, and an M.D. from Wake Forest University. He completed a General Surgery residency at the University of Chicago and completed a Cardiothoracic Surgery residency at the University of Michigan in June.
Dr. Long’s clinical interests include thoracic oncology (including cancer of the lung and esophagus), lung transplantation, ECMO, minimally invasive thoracic surgery including robotic surgery, and other lung and esophageal surgery.
His research interests include ex-vivo lung perfusion, use of lungs from non-heart-beating donors for transplantation, and international health. He recently became a co-investigator on a large NIH clinical trial grant at UNC, “More and Better Lungs: Ex-Vivo Perfusion of Lungs from Non-Heart-Beating Donors” (NHLBI grant 1 UM1 HL113115-01A1; Thomas Egan, principal investigator).
To make an appointment with Dr. Long, call (919) 966-3381.
UNC heart surgeon Andy Kiser developed a new, minimally invasive treatment for atrial fibrillation that treats the outside and inside surfaces of the heart. A heart surgeon and a cardiologist work together in the operating room to perform the Convergent Procedure, which has had a 70- to 80-percent success rate. The work of Dr. Kiser and cardiologist Dr. Paul Mounsey is featured in the August edition of Endeavors, UNC's online research magazine. Read the article .
In this video for StopAfib.org, Dr. Kiser discusses the procedure and the collaboration between cardiac surgeons and electrophysiologists at UNC.
A researcher at The University of North Carolina at Chapel Hill has received a $4 million, three-year grant from the National Institutes of Health to study assessment and transplantation of lungs from victims of sudden death. The National Heart, Lung, and Blood Institute awarded a $4,185,275 clinical trial grant to UNC for the study, which will begin Sept. 1 and will be led by Thomas M. Egan, M.D., M.Sc., principal investigator. Dr. Egan, a thoracic surgeon, is professor of surgery in the Division of Cardiothoracic Surgery, Department of Surgery at UNC.
Dr. Egan, who started the lung transplant program at UNC in 1989, is internationally known for his research on lung transplantation. His research has focused on use of lungs for transplant from patients who have died suddenly, outside the hospital, and have not been on mechanical ventilation. These are known as non-heart-beating donors (NHBDs). Dr. Egan has shown that lungs are still viable after circulation stops because lung cells obtain oxygen after death from air in the air sacs and airways (other organs require blood circulation to obtain oxygen). His lab has perfused and ventilated human lungs outside the body (ex vivo) to determine if they are suitable for transplant; the lab also has worked to show the safety of transplanting these lungs.
If successful, Dr. Egan’s project could greatly increase the number of lungs available for transplant. Currently, solid organs for transplant come primarily from patients who have suffered brain death and have been on mechanical ventilation before controlled circulatory arrest. However, many lungs from these donors cannot be used for transplant because of inflammation or infection during a prolonged interval of brain death. Lungs retrieved from NHBDs may not only be much more plentiful; they may be superior to lungs currently being transplanted from brain-dead donors.
Duke University (R. Duane Davis, M.D., principal investigator for the subaward), Carolina Donor Services, the regional organ procurement organization, and Lung Banks of America, a non-profit oganization, will have subawards on the grant. Wake County Emergency Medical Services, law enforcement, the medical examiner’s office and other government entities have cooperated to ensure the project is successful.
Lungs from the non-heart-beating donors that are found acceptable after ex-vivo assessment will be transplanted at UNC and Duke to patients who have consented to use of the lungs under FDA- and IRB-approved protocols. Outcomes will be compared to patients contemporaneously transplanted with lungs from conventional organ donors. If the trial is successful, it could lead to a broader study at more institutions. The grant is “More and Better Lungs: Ex-Vivo Perfusion of Lungs from Non-Heart-Beating Donors” (NHLBI grant 1 UM1 HL113115-01A1).
- Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery
Maryam, an 8-year-old girl from Afghanistan, underwent heart surgery at UNC Hospitals on Tuesday, July 9, and came through it well, her surgeon, Michael R. Mill, M.D., said. (Update: Maryam went home from the hospital to her host family's home in Raeford on Tuesday, July 16.)
Dr. Mill corrected a narrowing of Maryam's aorta (a surgical procedure called resection of coarctation of the aorta) and closed a fetal blood vessel, the ductus arteriosus, that had not closed normally when Maryam was a newborn (that surgery is called division of a ). )
"The procedure went well and she is doing fine postop," Dr. Mill said.
The ductus arteriosus is a vessel that allows blood to go around a baby's lungs before birth; after birth, it usually closes. If it does not, blood flows abnormally from the aorta to the pulmonary artery. Elman Frantz, M.D., a pediatric cardiologist at UNC, had planned to close the PDA in a catheter procedure on July 3. Dr. Frantz suspected the narrowing of the aorta after seeing results of an echocardiogram; he confirmed it during the catheter procedure. Narrowing makes it difficult for blood to flow through the aorta, the main artery that leads out of the heart. Surgery was necessary to fix the coarctation and if Dr. Frantz had closed the PDA, it would have made the surgery more difficult. So, both problems were fixed during surgery, Dr. Mill said.
Children often have high blood pressure before the operation because of the narrowing of the aorta and they need medication for a few days to weeks after surgery until the body adjusts to not having the aortic obstruction, Dr. Mill said.
The usual hospital stay after the surgery is five to seven days. "The blood pressure control is often what dictates how long the children need to stay in hospital," Dr. Mill said.
Maryam was flown to the United States in June Rita Bigham, a retired teacher from Chapel Hill and a UNC Hospitals volunteer, and her husband, Eric, worked with , a nonprofit group based in Mooresville, N.C., to arrange Maryam's trip and treatment. Solace for the Children brings children from Afghanistan and other war-torn countries to the United States to live with host families and receive medical care. Maryam’s care is being covered by the Rita and Eric Bigham Cardiology Special Project Fund, which the Bighams established with the Medical Foundation of North Carolina. Maryam has been staying since June 21 with a host family, Ashley Lewis and her family, in Raeford, and also has been paired with a "heart sister," Hannah Saye, 6, of Pinehurst, who had surgery for a heart defect when she was a newborn. Dr. Mill also did Hannah's surgery.
Dr. Mill, a pediatric cardiac surgeon, came to UNC in 1988 to be director of the UNC Heart and Heart-Lung Transplant programs. He performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina.
Dr. Mill helped the American Board of Thoracic Surgery develop the requirements for the first specialty certification in congenital cardiac surgery and in 2009 became one of the first physicians to earn that certification. He was chief of the Division of Cardiothoracic Surgery from 2000 to 2011 and has been director of the UNC cardiothoracic surgery residency program since 1998.
Dr. Mill earned an M.D. at the University of Colorado and did his residency in General Surgery there. He completed a residency in Thoracic Surgery and a fellowship in Heart and Heart-Lung Transplantation, both at Stanford University, where he trained with pioneering heart surgeon Norman Shumway.
Contact: Margaret Alford Cloud, UNC Division of Cardiothoracic Surgery, firstname.lastname@example.org
Tammy Allred, RN, OCN, is thoracic oncology and sarcoma nurse navigator at UNC Hospitals, helping lung cancer and sarcoma patients and their families at all stages of diagnosis and treatment. She's a good person to have on your side. UNC's Lineberger Cancer Center profiled Tammy in a recent article. Read it .
Congratulations to William E. Stansfield, M.D., who received the "Physician Teacher of the Year" award from residents in the UNC Department of Anesthesiology at a resident graduation dinner on June 22, 2013. Dr. Stansfield is a cardiac surgeon and an assistant professor of surgery in the UNC Division of Cardiothoracic Surgery.
Andy C. Kiser, MD, chief of the UNC Division of Cardiothoracic Surgery, presented an abstract, "Evaluation of integrated bipolar and unipolar epicardial ablation," at the International Society for Minimally Invasive Cardiac Surgery (ISMICS) meeting in Prague, Czech Republic, on June 13, 2013. Co-authors on the abstract were Hayden Pappas, MD, Kelly Garner, RN, Anil Gehi, MD, and Paul Mounsey, MD.
Read the abstract here.
Dr. Sheridan is a cardiac surgeon at UNC and is associate professor of surgery in the UNC Division of Cardiothoracic Surgery. He is director of Mechanical Circulatory Support and Cardiac Transplantation at UNC Hospitals. He has been chief editor of Cardiology Journal on eMedicine.com since 2007.
Mark Joseph, MD, a fellow in the UNC Division of Cardiothoracic Surgery, and Andy C. Kiser, MD, a professor of surgery and chief of the division, are authors of two chapters in the recently published TSRA Clinical Scenarios in Cardiothoracic Surgery. Their chapters are "Cardiac Trauma" and "Management of the Porcelain Aorta."
The TRSA Clinical Scenarios are published by the Thoracic Surgery Residents Association, American Association for Thoracic Surgery, Chicago. They are available here.
An article in EMS World, an online publication for EMS workers, features the lung transplant research of Thomas M. Egan, M.D., of the UNC Division of Cardiothoracic Surgery. Dr. Egan has studied the use of lungs for transplant from people who have died outside the hospital of sudden cardiac arrest. In a recent project, Dr. Egan worked with Wake County, NC, Emergency Medical Services to identify and help expedite the transport of cardiac arrest victims whose lungs could be evaluated by Dr. Egan's research team. Dr. Egan gave training to Wake County EMS crews on criteria for potential lung donors.
Read the article here.