Stuart W. Jamieson

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Stuart W. Jamieson
Stuart W. Jamieson.jpg
Stuart Jamieson in his library 2019
Born1947 (age 75–76)
Rhodesia
Education St Mary's Hospital Medical School, London
Occupation Cardiothoracic surgeon
Years active1978–present
Known forFirst to report that chronic thromboembolic pulmonary hypertension (CTEPH) can be corrected with Pulmonary thromboendarterectomy (PTE)
Medical career
Notable works
  • "Cardiac transplantation in 150 patients at Stanford University" BMJ (1979)
  • "Pulmonary endarterectomy: Experience and lessons learned in 1,500 cases" The Annals of Thoracic Surgery (2003)
Awards

Stuart William Jamieson FRCS (born 1947) is a British cardiothoracic surgeon, specialising in pulmonary thromboendarterectomy (PTE), a surgical procedure performed to remove organized clotted blood (thrombus) from pulmonary arteries in people with chronic thromboembolic pulmonary hypertension (CTEPH).

Contents

In his early career, he wrote on xenograft hyperacute rejection and in December 1980 was part of the team that performed the first successful human heart transplant using the then newly discovered immunosuppressant cyclosporine. In 1981, he was part of Bruce Reitz's team that performed the world's first successful combined heart-lung transplant procedure at Stanford University. Following that, he continued to make significant contributions to heart-lung transplant procedures, and led programmes in cardiothoracic surgery in both adults and children.

In 1986, he was elected president of the International Society for Heart and Lung Transplantation (ISHLT), whilst he was professor and head of cardiothoracic surgery at the University of Minnesota. Later, he became dean of cardiovascular affairs and chair and distinguished professor of surgery at the University of California, San Diego, where he co-founded the Sulpizio Cardiovascular Center.

Early life and education

Stuart Jamieson 2023 (his giraffe on screen) Stuart W. Jamieson at RSM 25 May 2023.png
Stuart Jamieson 2023 (his giraffe on screen)

Stuart Jamieson was born in 1947 [1] and brought up in Rhodesia (now Zimbabwe), where he was educated at Falcon College. [2] [3] His childhood was spent on a 2.5 million acre ranch with pets that included a zebra, an ostrich [4] and a giraffe. [5] At the age of 18, Jamieson was sent to St Mary's Hospital, affiliated with the University of London, to study medicine. [5] He financed his studies by working as a waiter. [4] [6]

Background

The first combined heart-lung transplant was accomplished by Denton Cooley in 1968, in Houston, in a two-year-old girl with severe pulmonary hypertension. Despite surviving less than a day, her case showed that this kind of procedure could be effective. [7] The second such transplant was performed in 1969, [8] by C. Walton Lillehei at Cornell University Medical Center in New York City, in a 43-year-old man with emphysema. He lived for eight days. [7] In 1971, South African Christiaan Barnard, also performed a combined heart-lung transplant in a 49-year-old man with emphysema, surviving for 23 days. [7] The poor survival rates of these early transplantations, primarily resulted from inadequate immunosuppression and difficulties with joining the airways. In addition, Joel D. Cooper had found corticosteroids to weaken the bronchial anastomosis. [9] It was on this background of tragic deaths that Jamieson later acknowledged and shared his research on xenograft hyperacute rejection. [5]

Early surgical career

Following 1971's Life Magazine's media coverage of failed early heart transplantations, Jamieson published his first papers on xenograft hyperacute rejection in 1974 and 1975. [5] [10]

In 1978, the American Heart Association awarded him a fellowship to study at Stanford University under the pioneering heart surgeon Norman Shumway, who had performed the first human heart transplant in America in 1967. [4] [11] Jamieson completed his residency in 1980 [12] and stayed on as chief resident at Shumway's request. [5] Later, he was listed in Clinical Cardiology (2000), as one of Norman Shumway's distinguished trainees. [12]

Before 1980, just under 40 lung transplantation procedures had been attempted, all of which resulted in the patient's death within a few months and just one resulted in the patient's discharge from hospital. [5] In 1979 at Stanford, Jamieson performed 25 heart transplants, comprising more than 50 percent of the total performed globally at that time. [1]

In 1979, he described a series of successful transplantations in primates using cyclosporine, a fungal derivative whose immunosuppressive properties were reported by Jean-Francois Borel. [5] Observing Roy Calne's reports on how cyclosporine led to a reduction in acute rejection and consequent longer survival rates following liver and kidney transplantation, [9] Jamieson then demonstrated the possibility of using cyclosporine in human heart-lung transplantations. [13] Subsequently, with Edward Stinson and Norman Shumway, he published Stanford's achievements in a report in the British Medical Journal (BMJ) on "Cardiac transplantation in 150 patients at Stanford University". [14] This report was one of the developments that supported the recommencement of heart surgery in the UK under Sir Terence English in 1979. [15]

In December 1980, he participated in the first successful human heart transplant using cyclosporine. [5] [16] The recipient was then age 20 and still living in 2017 at the age of 58. [5]

Stanford group

On 9 March 1981, Jamieson was part of the team that achieved the first long-term survival following a combined heart-lung transplant procedure, led by Bruce Reitz [17] and accompanied by John Wallwork and Norman Shumway. The recipient, a 45-year-old woman with Eisenmenger's syndrome, lived for 5 years. [5] [7] A series of combined heart-lung transplant procedures followed in which alternative blood vessels provided blood to the main airways, reducing bronchial restricted blood supply since the coronary blood vessels remained intact after the bronchial artery had been ligated. Use of cyclosporine reduced acute rejection. [7] [18] [19]

Simultaneous work in Toronto, under Joel D. Cooper and the Toronto transplant group also reported success with single-lung transplants and then with en bloc bilateral lung transplants. [7] Over the next two decades, the state of lung transplantation grew and multiple lung transplant centers became global. Bilateral and single-lung transplants continued to account for most procedures performed. Heart-lung transplants became reserved primarily for those patients with the Eisenmenger anomaly or severe primary pulmonary hypertension. [18] Jamieson was responsible for numerous descriptions of early heart-lung and double lung transplant techniques. [20]

He co-founded the International Society for Heart and Lung Transplantation (ISHLT) in 1981 and later became its president in 1986. [20]

In 1982, Jamieson became the director of heart and lung transplantation at Stanford and retained this position until 1986. [2]

Minnesota

University of Minnesota East Bank campus in the winter Northrop Mall Winter.png
University of Minnesota East Bank campus in the winter

In 1986, Jamieson replaced Walton Lillehei at University of Minnesota as director of the Minnesota Heart and Lung Institute, [4] performing Minnesota's first heart-lung transplant in the same year. In 1988, he performed the Midwest's first double-lung transplant. [21]

San Diego

UC San Diego Medical Center in Hillcrest UCSD Medical Center Hillcrest.jpg
UC San Diego Medical Center in Hillcrest
The Sulpizio Family Cardiovascular Center houses the Departments of Cardiology and Emergency Medicine in La Jolla Sulpizio Cardiovascular Center.jpg
The Sulpizio Family Cardiovascular Center houses the Departments of Cardiology and Emergency Medicine in La Jolla

By 1989, Jamieson had transferred his entire surgical team, including Michael Peter Kaye, [22] to the University of California, San Diego. [4] [6] to which he introduced heart-lung, lung, double lung and living-related transplant, and established the first lung transplantation programme to be Medicare certified and co-founded the Sulpizio Cardiovascular Center [5]

The International Registry for Heart Transplantation, which possesses global heart and heart-lung transplants records, and the editorial offices of the Journal of Heart Transplantation also moved to UCSD Medical Center. [3] [23]

Heart-lung surgery

pulmonary endarterectomy PEA specimen.tif
pulmonary endarterectomy

By 1989, he had performed around 500 heart transplants and more than 50 heart-lung transplants. [3] However, due to the shortage of donor supplies, an attempt was made to reduce heart-lung transplants. The heart was increasingly repaired where possible and pulmonary thromboendarterectomy (PTE) performed for Chronic thromboembolic pulmonary hypertension (CTEPH). [5]

PTE is an operation that removes organized clotted blood (thrombus) from the pulmonary arteries of people with chronic thromboembolic pulmonary hypertension (CTEPH). [24] Many physicians have been unaware of the existence of CTEPH and as a consequence it has been underdiagnosed. Jamieson was the first to report that CTEPH can be corrected with PTE. [25]

Jamieson's 2003 publication, describing the first 1,500 cases of PTE, confirmed the benefits of surgery and dismissed the myth that poor right ventricular function disqualified a patient as fit for surgery. [26] He argued that whatever the degree of right ventricular failure, PTA improved patients lives. [26] While medical management may provide some temporary relief of symptoms, PTE is considered curative for CTEPH. [27] [28]

By 2011 there were approximately 30 centers worldwide that offered pulmonary endarterectomy and half of the 4,000 procedures performed were being done by Jamieson's programme directorship at University of California, San Diego (UCSD). [26]

Jamieson pioneered the procedure of pulmonary thromboendarterectomy (PTE). [29] [30] During his four decades at UCSD, he made modifications to the procedure of PTE, adapted surgical instruments and proposed a classification of CTEPH. [5]

Karen (orangutan)

In 1994, Jamieson led the team that performed the first open heart surgery on an orangutan, Karen, at San Diego Zoo. He repaired her penny-size hole in the heart when she was two years old. She recovered and made headlines. [31] [32]

Personal life

Jamieson is a cattle rancher and commercial helicopter pilot. [29] He has three children. [4]

Awards

Selected publications

Jamieson has published more than 500 scientific papers and authored two key medical textbooks on heart and lung surgery. [29]

Autobiography

Book chapters

Journal articles

Related Research Articles

<span class="mw-page-title-main">Pulmonary hypertension</span> Increased blood pressure in lung arteries

Pulmonary hypertension is a condition of increased blood pressure in the arteries of the lungs. Symptoms include shortness of breath, fainting, tiredness, chest pain, swelling of the legs, and a fast heartbeat. The condition may make it difficult to exercise. Onset is typically gradual.

<span class="mw-page-title-main">Fontan procedure</span> Surgical procedure used in children with univentricular hearts

The Fontan procedure or Fontan–Kreutzer procedure is a palliative surgical procedure used in children with univentricular hearts. It involves diverting the venous blood from the inferior vena cava (IVC) and superior vena cava (SVC) to the pulmonary arteries. The procedure varies for differing congenital heart pathologies. For example in tricuspid atresia, the procedure can be done where the blood does not pass through the morphologic right ventricle; i.e., the systemic and pulmonary circulations are placed in series with the functional single ventricle. Whereas in hypoplastic left heart syndrome, the heart is more reliant on the more functional right ventricle to provide blood flow to the systemic circulation. The procedure was initially performed in 1968 by Francis Fontan and Eugene Baudet from Bordeaux, France, published in 1971, simultaneously described in 1971 by Guillermo Kreutzer from Buenos Aires, Argentina, and finally published in 1973.

<span class="mw-page-title-main">Endarterectomy</span> Surgical procedure

Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of deposits. It is carried out by separating the plaque from the arterial wall.

<span class="mw-page-title-main">Pulmonary thromboendarterectomy</span>

In thoracic surgery, a pulmonary thromboendarterectomy (PTE), also referred to as pulmonary endarterectomy (PEA), is an operation that removes organized clotted blood (thrombus) from the pulmonary arteries, which supply blood to the lungs.

Bruce A. Reitz is an American cardiothoracic surgeon, best known for leading the first combined heart-lung transplantation in 1981 with pioneer heart transplant surgeon Norman Shumway. He obtained an undergraduate degree at Stanford University a medical degree at Yale Medical School and completed an internship at Johns Hopkins Hospital (1971) and residencies and fellowships at Stanford University Hospital the National Institutes of Health (1974). He joined the surgical faculty at Stanford University (1978) then became chief of cardiac surgery at Johns Hopkins University (1982–92) and Chairman of the Department of Cardiothoracic Surgery at Stanford (1992–2005). In 1995 he conducted another pioneering operation: the first Heartport procedure, using a device that allows minimally invasive coronary bypass and valve operations. Reitz also played a major role in the resident education program at Stanford, which he reorganized and maintained.

<span class="mw-page-title-main">Royal Papworth Hospital</span> Hospital in England

Royal Papworth Hospital is a specialist heart and lung hospital, located on the Cambridge Biomedical Campus in Cambridgeshire, England. The Hospital is run by Royal Papworth Hospital NHS Foundation Trust.

<span class="mw-page-title-main">Atrial septostomy</span> Surgical procedure on the heart

Atrial septostomy is a surgical procedure in which a small hole is created between the upper two chambers of the heart, the atria. This procedure is primarily used to palliate dextro-Transposition of the great arteries or d-TGA, a life-threatening cyanotic congenital heart defect seen in infants. It is performed prior to an arterial switch operation. Atrial septostomy has also seen limited use as a surgical treatment for pulmonary hypertension. The first atrial septostomy was developed by Vivien Thomas in a canine model and performed in humans by Alfred Blalock. The Rashkind balloon procedure, a common atrial septostomy technique, was developed in 1966 by American cardiologist William Rashkind at the Children's Hospital of Philadelphia.

Norman Edward Shumway was a pioneer of heart surgery at Stanford University. He was the 67th president of the American Association for Thoracic Surgery and the first to perform an adult human to human heart transplantation in the United States.

<span class="mw-page-title-main">Heart transplantation</span> Surgical transplant procedure

A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. As of 2018, the most common procedure is to take a functioning heart, with or without both lungs, from a recently deceased organ donor and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart or, much less commonly, the recipient's diseased heart is left in place to support the donor heart.

Sharon Ann Hunt is a cardiology professor and Director of the Post Heart Transplant Programme in Palo Alto, California and is affiliated with Stanford University Medical Center, professionally known for her work in the care of patients after heart transplantation.

<span class="mw-page-title-main">Hans-Joachim Schäfers</span> German surgeon, as well as cardiac, thoracic, and vascular surgeon

Hans-Joachim Schäfers is a German surgeon, as well as cardiac, thoracic, and vascular surgeon and university professor. He is director of the department of Thoracic and Cardiovascular Surgery at the Saarland University Medical Center in Homburg/Saar, Germany. He is known for his activities in aortic valve repair, aortic surgery, and pulmonary endarterectomy.

<span class="mw-page-title-main">Christian Cabrol</span> French cardiac surgeon

Christian Emile Cabrol was a French cardiac surgeon best known for performing Europe's first heart transplant at Pitié-Salpêtrière Hospital in 1968.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term disease caused by a blockage in the blood vessels that deliver blood from the heart to the lungs. These blockages cause increased resistance to flow in the pulmonary arterial tree which in turn leads to rise in pressure in these arteries. The blockages either result from organised blood clots that usually originate from the deep veins of the lower limbs of the body (thromboembolism) and lodge in the pulmonary arterial tree after passing through the right side of the heart. The blockages may also result from scar tissue that forms at the site where the clot has damaged the endothelial lining of the pulmonary arteries, causing permanent fibrous obstruction. Most patients have a combination of microvascular and macrovascular obstruction. Some patients may present with normal or near-normal pulmonary pressures at rest despite symptomatic disease. These patients are labelled as having chronic thromboembolic disease (CTED).

Philip Caves (1940–1978) was an Irish cardiothoracic surgeon. In 1972, while at Stanford University, he pioneered the use of the bioptome and transvenous endomyocardial biopsy in the early diagnosis of heart transplant rejection. It was considered the most significant advance in antirejection therapy of the time. Awarded the British American Research Fellowship in 1971, Caves worked with pioneering cardiothoracic surgeon Norman Shumway at Stanford and became staff surgeon leading the transplant programme by 1973. A year later he went to Edinburgh as a senior lecturer in cardiac surgery, where he became particularly interested in pediatric cardiac surgery.

<span class="mw-page-title-main">International Society for Heart and Lung Transplantation</span>

The International Society for Heart and Lung Transplantation (ISHLT), established in 1981, is a professional organization committed to research and education in heart and lung disease and transplantation. It holds annual scientific meetings and publishes The Journal of Heart and Lung Transplantation. It also holds the worlds largest registry of heart and lung transplant data.

Jack Greene Copeland is an American cardiothoracic surgeon, who has established procedures in heart transplantation including repeat heart transplantation, the implantation of total artificial hearts (TAH) to bridge the time to heart transplant, innovations in left ventricular assist devices (LVAD) and the technique of "piggybacking" a second heart in a person, while leaving them the original.

<span class="mw-page-title-main">Michael Peter Kaye</span>

Michael Peter Kaye was an American surgeon and researcher who co-founded the International Society for Heart and Lung Transplantation (ISHLT) in 1981. He developed the society's registry and edited the Journal of Heart and Lung Transplantation.

Edward B. Stinson is an American retired cardiothoracic surgeon living in Los Altos, United States, who assisted Norman Shumway in America's first adult human-to-human heart transplantation on 6 January 1968 at Stanford University.

<span class="mw-page-title-main">Michael L. Hess</span>

Michael L. Hess was an American professor of cardiology and physiology at the Medical College of Virginia (MCV) who was instrumental in founding the International Society for Heart and Lung Transplantation (ISHLT), of which he served as its first president.

<span class="mw-page-title-main">Balloon pulmonary angioplasty</span>

Balloon pulmonary angioplasty (BPA) is an emerging minimally invasive procedure to treat chronic thromboembolic pulmonary hypertension (CTEPH) in people who are not suitable for pulmonary thromboendarterectomy (PTE) or still have residual pulmonary hypertension and areas of narrowing in the pulmonary arterial tree following previous PTE.

References

  1. 1 2 "Organ transplants have come far, but there's more to be done". Orange County Register. 19 February 2014. Retrieved 7 July 2018.
  2. 1 2 Dunning, Joel. "Stuart Jamieson, MD". Archived from the original on 6 June 2023.{{cite journal}}: Cite journal requires |journal= (help)
  3. 1 2 3 Wolf, Leslie (7 April 1989). "Leading Heart Surgeon to Join Staff at UCSD". Los Angeles Times. ISSN   0458-3035. Archived from the original on 6 June 2023. Retrieved 25 June 2018.
  4. 1 2 3 4 5 6 Stanger, Shelby (May 2011). San Diego Magazine. CurtCo/SDM LLC. p. 80. Archived from the original on 6 June 2023.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 Valentine, Vincent (2017). "Recapitulation of the Opening Plenary Session: San Diego 2017" (PDF). www.ISHLT.org.
  6. 1 2 3 4 "UCSD transplant surgeon Stuart Jamieson to receive prestigious pioneer award". UC San Diego School of Medicine. Archived from the original on 6 June 2023. Retrieved 30 June 2018.
  7. 1 2 3 4 5 6 Margreiter, R. (October 2016). "History of Lung and Heart-Lung Transplantation, With Special Emphasis on German-Speaking Countries". Transplantation Proceedings. 48 (8): 2779–2781. doi:10.1016/j.transproceed.2016.07.015. ISSN   0041-1345. PMID   27788817.(subscription required)
  8. ↑ "C. Walton Lillehei, the "Father of Open Heart Surgery"". Circulation. 100 (13): 1364–1365. 1999-09-28. doi: 10.1161/01.CIR.100.13.1364 . ISSN   0009-7322. PMID   10500033.
  9. 1 2 Yeung, Jonathan C.; Keshavjee, Shaf (January 2014). "Overview of Clinical Lung Transplantation". Cold Spring Harbor Perspectives in Medicine. 4 (1): a015628. doi:10.1101/cshperspect.a015628. ISSN   2157-1422. PMC   3869283 . PMID   24384816.
  10. ↑ Jamieson, S. W. (May 1974). "Xenograft hyperacute rejection. A new model". Transplantation. 17 (5): 533–534. doi: 10.1097/00007890-197405000-00016 . ISSN   0041-1337. PMID   4597184.
  11. ↑ Altman, Lawrence K. (2006-02-11). "Norman E. Shumway, 83, Who Made the Heart Transplant a Standard Operation, Dies". The New York Times. ISSN   0362-4331 . Retrieved 4 July 2018.
  12. 1 2 Willis Hurst, J.; Bruce Fye, W.; Robbins, Robert C. (June 2000). "Norman E. Shumway". Clinical Cardiology. 23 (6): 462–466. doi:10.1002/clc.4960230620. ISSN   0160-9289. PMC   6654789 . PMID   10875041.
  13. ↑ Puerto Rico Health Sciences Journal. University of Puerto Rico Medical Sciences Campus. 1987. p. 55.
  14. ↑ Hamilton, David (2012). "Notes". A History of Organ Transplantation: Ancient Legends to Modern Practice. Pittsburgh: University of Pittsburgh Pre. p. 509. ISBN   978-0-8229-4413-3.
  15. ↑ New Scientist. Reed Business Information. 18 January 1979. p. 155.
  16. ↑ Borel, J. F.; Kis, Z. L.; Beveridge, T. (2012). "Chapter 2 The History of the Discovery and Development of Cyclosporine". In Merluzzi, Vincent J.; Adams, Julian (eds.). The Search for Anti-Inflammatory Drugs: Case Histories from Concept to Clinic. Springer Science & Business Media. p. 58. ISBN   978-1-4615-9848-0.
  17. ↑ "World's first successful heart-lung transplant". Stanford 125. 8 April 2016. Retrieved 27 June 2018.
  18. 1 2 McShane, Pamela J.; Ruiz, Luis G.; Garrity, Edward R. (2012). "75. Clinical Respiratory Medicine". Clinical respiratory medicine. Spiro, Stephen G., Silvestri, Gerard A., Agustí, Alvar. (4th ed.). Philadelphia, PA: Elsevier Saunders. pp. 882–903. ISBN   978-1455723294. OCLC   810330412.
  19. ↑ D.K. Cooper, ed. (1990). The Transplantation and Replacement of Thoracic Organs: The Present Status of Biological and Mechanical Replacement of the Heart and Lungs. Dimitry Novitzky. Kluwer Academic Publishers. ISBN   978-94-010-6805-5.
  20. 1 2 "ISHLT: The International Society for Heart & Lung Transplantation - Other Achievement Awards". www.ishlt.org. Retrieved 9 July 2018.
  21. ↑ Heim, Michael (2004). Exploring America's Highways: Minnesota Trip Trivia. Exploring America's Highway. p. 42. ISBN   978-0-9744358-1-7.
  22. ↑ Jamieson, Stuart (April 2018). "Dr. Michael Peter Kaye". The Journal of Heart and Lung Transplantation. 37 (4): 534. doi:10.1016/j.healun.2018.01.001. ISSN   1053-2498. PMID   29398282.
  23. ↑ "Stuart W Jamieson | RadcliffeCardiology". www.radcliffecardiology.com. Retrieved 30 June 2018.
  24. ↑ "Causes". nhs.uk. 23 October 2017. Retrieved 7 July 2018.
  25. ↑ Cerveri, I; D’Armini, A M; Viganò, M (April 2003). "Pulmonary thromboendarterectomy almost fifty years after the first surgical attempts". Heart. 89 (4): 369–370. doi:10.1136/heart.89.4.369. ISSN   1355-6037. PMC   1769265 . PMID   12639858.
  26. 1 2 3 Ryan, John J.; Rich, Stuart; Archer, Stephen L. (2011). "Pulmonary Endarterectomy Surgery- A Technically Demanding Cure for WHO Group IV Pulmonary Hypertension: Requirements for Centers of Excellence and Availability in Canada". The Canadian Journal of Cardiology. 27 (6): 671–674. doi:10.1016/j.cjca.2011.09.013. ISSN   0828-282X. PMC   3555483 . PMID   22019277.
  27. ↑ Banks, Dalia A.; Manecke, Gerard R.; Maus, Timothy M.; Kerr, Kim M.; Jamieson, Stuart W. (2011). Joel A. Kaplan (ed.). Kaplan's Cardiac Anesthesia E-Book: Expert Consult Premium. David L. Reich, Steven N. Konstadt. Elsevier Saunders. p. 755. ISBN   978-1-4377-1617-7.
  28. ↑ Kim, Nick H. (2016). Pulmonary hypertension. Oudiz, Ronald J. Philadelphia: Elsevier. p. 439. ISBN   9780323459600. OCLC   958566777.
  29. 1 2 3 "Stuart Jamieson | UCSD Profiles". profiles.ucsd.edu. Retrieved 17 June 2018.
  30. ↑ Piette, Jean-Charles; Hunt, Beverley J. (2006). "11 Pulmonary Hypertension and Antiphospholipid Antibodies". In Munther A Khamashta (ed.). Hughes Syndrome: Antiphospholipid Syndrome (2nd ed.). Springer. p. 120. ISBN   978-1-85233-873-2.
  31. ↑ Irvine, Georgeanne (2018). Karen's Heart: The True Story of a Brave Baby Orangutan. San Diego Zoo Global Press. ISBN   9781943198047.
  32. ↑ "Open-Heart Surgery Performed On Orangutan". The Washington Post . 27 August 1994. Retrieved 24 March 2019.
  33. ↑ "Irvine H. Page Young Investigator Research Award". professional.heart.org. Retrieved 20 May 2018.
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