Clinical Focus


  • Anesthesia

Academic Appointments


  • Clinical Assistant Professor, Anesthesiology, Perioperative and Pain Medicine

Professional Education


  • Board Certification: National Board of Echocardiography, Perioperative Transesophageal Echocardiography (2020)
  • Board Certification: American Board of Anesthesiology, Anesthesia (2019)
  • Fellowship: Stanford University Anesthesiology Fellowships (2019) CA
  • Residency: Stanford University Anesthesiology Residency (2018) CA
  • Internship: Stony Brook University Dept of Medicine (2015) NY
  • Medical Education: SUNY Stony Brook School of Medicine Registrar (2014) NY
  • Residency, Stanford University School of Medicine, Anesthesiology (2018)
  • Internship, Stony Brook University School of Medicine, Internal Medicine (2015)
  • MD, Stony Brook University School of Medicine, Medicine (2014)
  • PhD, Stony Brook University School of Medicine, Neuroscience (2011)

All Publications


  • A case report of an open aortic valve replacement followed by open adrenalectomy in a patient with symptomatic pheochromocytoma and critical aortic stenosis. Journal of cardiothoracic surgery Feinstein, I., Lee, T., Khan, S., Raleigh, L., Mihm, F. 2021; 16 (1): 282

    Abstract

    BACKGROUND: Pheochromocytoma is a rare medical condition caused by catecholamine-secreting tumor cells. Operative resection can be associated with significant hemodynamic fluctuations due to the nature of the tumor, as well as associated post-resection vasoplegia. To allow for cardiovascular recovery before surgery, patients require pre-operative alpha-adrenergic blockade, which would be limited in the setting of co-existent severe aortic stenosis. In this report, we describe a patient with severe aortic stenosis and symptomatic pheochromocytoma.CASE PRESENTATION: A 51-year-old man with severe aortic stenosis (valve area 0.8 cm2) was found to have a highly active 4*4cm left adrenal pheochromocytoma. Alpha-adrenergic blockade for his pheochromocytoma was limited by syncope in the setting of his aortic stenosis. Open aortic valve replacement (AVR) was performed, followed by adrenalectomy the next day. The perioperative course for each surgical procedure was hemodynamically volatile, exacerbated by severe alcohol withdrawal. During the adrenalectomy, cardiogenic and vasoplegic shock developed immediately after securing the vascular supply to his tumor. This shock was refractory to vasopressin and methylene blue, but responded well to angiotensin II and epinephrine. After both surgeries were completed, his course was further complicated by severe ICU psychosis, ileus, fungal bacteremia, pneumonia/hypoxic respiratory failure and atrial fibrillation. He ultimately recovered and was discharged from the hospital after 38days.CONCLUSION: To our knowledge, this is the first report of surgical AVR and pheochromocytoma resection in a patient with critical aortic stenosis. The appropriate order and timing of surgeries when both these conditions co-exist remains controversial.

    View details for DOI 10.1186/s13019-021-01665-x

    View details for PubMedID 34583724

  • Plasma Biomarkers of Tau and Neurodegeneration During Major Cardiac and Noncardiac Surgery. JAMA neurology Feinstein, I., Wilson, E. N., Swarovski, M. S., Andreasson, K. I., Angst, M. S., Greicius, M. D. 2021

    View details for DOI 10.1001/jamaneurol.2021.2823

    View details for PubMedID 34542578

  • First lung and kidney multi-organ transplant following COVID-19 Infection. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Guenthart, B. A., Krishnan, A., Alassar, A., Madhok, J., Kakol, M., Miller, S., Cole, S. P., Rao, V. K., Acero, N. M., Hill, C. C., Cheung, C., Jackson, E. C., Feinstein, I., Tsai, A. H., Mooney, J. J., Pham, T., Elliott, I. A., Liou, D. Z., La Francesca, S., Shudo, Y., Hiesinger, W., MacArthur, J. W., Brar, N., Berry, G. J., McCarra, M. B., Desai, T. J., Dhillon, G. S., Woo, Y. J. 2021

    Abstract

    As the world responds to the global crisis of the COVID-19 pandemic an increasing number of patients are experiencing increased morbidity as a result of multi-organ involvement. Of these, a small proportion will progress to end-stage lung disease, become dialysis dependent, or both. Herein, we describe the first reported case of a successful combined lung and kidney transplantation in a patient with COVID-19. Lung transplantation, isolated or combined with other organs, is feasible and should be considered for select patients impacted by this deadly disease.

    View details for DOI 10.1016/j.healun.2021.02.015

    View details for PubMedID 34059432