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Manuel V, Miana LA, Fonseca-Alaniz MH, Hernan GC, Tenório DF, Bado C, de Carvalho MLP, Meirelles M, Telles JPM, Penha JG, Tanamati C, Caneo LF, Krieger JE, Jatene FB, Jatene MB. Myocardial tissue expression of mRNA and preoperative neutrophil-lymphocyte ratio in children undergoing congenital heart surgery. Transl Pediatr 2024; 13:248-259. [PMID: 38455742 PMCID: PMC10915444 DOI: 10.21037/tp-23-513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/11/2023] [Indexed: 03/09/2024] Open
Abstract
Background The neutrophil-lymphocyte ratio (NLR) is an easily accessible and inexpensive biomarker that has been shown to predict morbidity and mortality in congenital cardiac surgery. However, its regulatory mechanism remains unclear. This study aims to compare and correlate the tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, and IL-10 messenger RNAs (mRNAs) with the NLR in patients with tetralogy of Fallot (ToF) and ventricular septal defect (VSD). Methods A prospective translational study was conducted on 10 children with ToF and 10 with VSD, aged between 1 and 24 months. The NLR was calculated from the blood count taken 24 hours before surgery. The expression of these mRNAs was analyzed in the myocardial tissue of the right atrium prior to cardiopulmonary bypass. Results Patients with ToF exhibited a higher NLR [ToF 0.46 (interquartile range; IQR) 0.90; VSD 0.28 (IQR 0.17); P=0.02], longer mechanical ventilation time [ToF 24 h (IQR 93); VSD 5.5 h (IQR 8); P<0.001], increased use of vasoactive drugs [ToF 2 days (IQR 1.75); VSD 0 (IQR 1); P=0.01], and longer ICU [ToF 5.5 (IQR 1); VSD 2 (IQR 0.75); P=0.02] and hospital length of stays [ToF 18 days (IQR 17.5); VSD 8.5 days (IQR 2.5); P<0.001]. A negative correlation was found between NLR and oxygen saturation (SaO2) (r=-0.44; P=0.002). In terms of mRNA expression, the ToF group showed a lower expression of IL-10 mRNA (P=0.03). A positive correlation was observed between IL-10-mRNA and SaO2 (r=0.40; P=0.07), and a negative correlation with NLR (r=-0.27; P=0.14). Conclusions Patients with ToF demonstrated a higher preoperative NLR and lower IL-10 mRNA expression by what appears to be a pro-inflammatory phenotype of cyanotic patients.
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Affiliation(s)
- Valdano Manuel
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
- Cardiovascular and Thoracic Service, Complexo Hospitalar de Doenças Cardio-Pumonares Cardeal Dom Alexandre do Nascimento, Luanda, Angola
| | - Leonardo A. Miana
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Miriam Helena Fonseca-Alaniz
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Gabriel Carrillo Hernan
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Davi Freitas Tenório
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Celestino Bado
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mariana Lombardi Peres de Carvalho
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Matheus Meirelles
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - João Paulo Mota Telles
- Department of Neurology, Instituto Central, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Juliano Gomes Penha
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carla Tanamati
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luiz Fernando Caneo
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fábio Biscegli Jatene
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcelo Biscegli Jatene
- Cardiovascular Division, Instituto do Coração (Heart Institute), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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Azeka E, Siqueira AWDS, Tanaka AC, Massoti MRB, Miana L, Zorzanelli L, Guimarães V, Penha J, Caneo LF, Tanamati C, Miura N, Jatene MB. Heart Transplantation in Children and Adults With Congenital Heart Disease: 3 Decades of Evolution. Transplant Proc 2023; 55:1429-1430. [PMID: 37344300 DOI: 10.1016/j.transproceed.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
Heart transplantation is the treatment of choice for children and adults with congenital heart disease. We report the heart transplant single-center experience. The number of transplantations has increased over the last 3 decades. The Kaplan-Meier survival curves in the first, second, and third decades at 5 and 10 years were 69% and 59%, 62% and 52%, and 66% and 60%, respectively.
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Affiliation(s)
- Estela Azeka
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil.
| | | | - Ana Cristina Tanaka
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Maria Raquel Brigoni Massoti
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Leonardo Miana
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Leina Zorzanelli
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Vanessa Guimarães
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Juliano Penha
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Luiz Fernando Caneo
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Carla Tanamati
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Nana Miura
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
| | - Marcelo Biscegli Jatene
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo Brazil
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Caneo LF, Matte GS, R Turquetto AL, Pegollo LMDC, Amato Miglioli MC, T de Souza G, Amato LP, Miana LA, B Massoti MR, Penha JG, Tanamati C, Jatene MB, Jatene FB. Initial experience with del Nido cardioplegia solution at a Pediatric and Congenital Cardiac Surgery Program in Brazil. Perfusion 2021; 37:684-691. [PMID: 34080462 DOI: 10.1177/02676591211020471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate outcome measures between our standard multidose cardioplegia protocol and a del Nido cardioplegia protocol in congenital heart surgery patients. METHODS Retrospective single-center study including 250 consecutive patients that received del Nido cardioplegia (DN group) with a mandatory reperfusion period of 30% of cross clamp time and 250 patients that received a modified St. Thomas' solution (ST group). Groups were matched by age, weight, gender, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores. Preoperative hematocrit and oxygen saturation were also recorded. Outcomes analyzed were the vasoactive inotropic score (VIS), lactate, ventilation time, ventricular dysfunction with low cardiac output syndrome (LCOS), intensive care unit (ICU) length of stay (LOS), hospital LOS, bypass and aortic cross-clamp times, and in-hospital mortality. RESULTS Both groups were comparable demographically. Statistically significant differences (p ⩽ 0.05) were noted for cardiac dysfunction with LCOS, hematocrit at end of surgery (p = 0.0038), VIS on ICU admission and at end of surgery (p = 0.0111), and ICU LOS (p = 0.00118) with patients in the DN group having more desirable values for those parameters. Other outcome measures did not reach statistical significance. CONCLUSION In our congenital cardiac surgery population, del Nido cardioplegia strategy was associated with less ventricular dysfunction with LCOS, a lower VIS and decreased ICU LOS compared with patients that received our standard myocardial protection using a modified St. Thomas' solution. Despite the limitation of this study, including its retrospective nature and cohort size, these data supported our transition to incorporate del Nido cardioplegia solution with a mandatory reperfusion period as the preferred myocardial protection method in our program.
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Affiliation(s)
- Luiz Fernando Caneo
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Gregory S Matte
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Aida Luiza R Turquetto
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Luana Marques de Carvalho Pegollo
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Maria Clara Amato Miglioli
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Gisele T de Souza
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Luciana Patrick Amato
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Leonardo A Miana
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Maria Raquel B Massoti
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Juliano G Penha
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Carla Tanamati
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Marcelo B Jatene
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
| | - Fabio B Jatene
- Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil
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Azeka E, Walker T, Siqueira AWDS, Penha J, Miana L, Caneo LF, Massoti MR, Tanamati C, Miura N, Jatene MB. Heart Retransplantation for Coronary Allograft Vasculopathy in Children: 25 Years of Single-Center Experience. Transplant Proc 2020; 52:1394-1396. [PMID: 32387081 DOI: 10.1016/j.transproceed.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/22/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pediatric end-stage heart disease is surgically managed by heart transplantation. A major complication of primary transplantation (PTx) is coronary allograft vasculopathy (CAV), a form of accelerated atherosclerosis. Retransplantation (RTx) has been the management of CAV; however, there is limited comprehensive literature on this subject. Here we report 25 years of single-center experience in managing CAV with RTx and place it in the context of recent studies. METHODS A retrospective cohort study was undertaken on patients who underwent PTx <18 years old and subsequent RTx due to CAV at the Heart Institute (InCor) University of São Paulo Medical School between 1992 and 2018. The maintenance immunosuppression protocol was double immunosuppression. For both PTx and RTx, quantitative and qualitative analyses were conducted for transplantation indication, donor/recipient demographics, post-transplant survival, rejection, infection, and immunosuppression. RESULTS Between 1992 and 2018, 200 children underwent heart transplantation. Ten re-transplantations were performed, for which 7 (70%) were for CAV. Ages at RTx ranged from 11.5 to 29.3 years (19.1 ± 5.68 years; median 18.2 years). The mean time between PTx and RTx was 12.9 ± 3.4 years (median 13.4 years). The Kaplan-Meier survival rate at 1 month, 3 years, and 5 years was 85.7%, 71.5%, and 47.6%, respectively. CONCLUSION Cardiac RTx can be a management option for CAV in patients who have undergone PTx in childhood with double immunosuppression therapy.
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Affiliation(s)
- Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
| | - Thomas Walker
- University of Southampton Medical School, University of Southampton, Southampton, United Kingdom
| | | | - Juliano Penha
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Leonardo Miana
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Fernando Caneo
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Maria Raquel Massoti
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carla Tanamati
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Nana Miura
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Silva GVRD, Miana LA, Caneo LF, Turquetto ALR, Tanamati C, Penha JG, Jatene FB, Jatene MB. Early and Long-Term Outcomes of Surgical Treatment of Ebstein's Anomaly. Braz J Cardiovasc Surg 2019; 34:511-516. [PMID: 31364344 PMCID: PMC6852467 DOI: 10.21470/1678-9741-2018-0333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. METHODS A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. RESULTS Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. CONCLUSION In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.
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Affiliation(s)
- Guilherme Viotto Rodrigues da Silva
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Leonardo Augusto Miana
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Fernando Caneo
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Aída Luiza Ribeiro Turquetto
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Carla Tanamati
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Juliano G Penha
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Marcelo B Jatene
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Manuel V, Miana LA, Guerreiro GP, Tenório DF, Turquetto A, Penha JG, Massoti MR, Tanamati C, Junior APF, Caneo LF, Jatene FB, Jatene MB. Prognostic value of the preoperative neutrophil‐lymphocyte ratio in patients undergoing the bidirectional Glenn procedure. J Card Surg 2019; 35:328-334. [DOI: 10.1111/jocs.14381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Valdano Manuel
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
- Cardio‐Thoracic CenterClínica GirassolLuanda Angola
| | - Leonardo A. Miana
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Gustavo P. Guerreiro
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Davi F. Tenório
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Aida Turquetto
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Juliano G. Penha
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Maria R. Massoti
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Carla Tanamati
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | | | - Luiz F. Caneo
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Fábio B. Jatene
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Marcelo B. Jatene
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
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Fernandes GC, Silva GVRD, Caneo LF, Tanamati C, Turquetto ALR, Jatene MB. Outcomes of the Conversion of the Fontan-Kreutzer Operation to a Total Cavopulmonary Connection for the Failing Univentricular Circulation. Arq Bras Cardiol 2019; 112:130-135. [PMID: 30785577 PMCID: PMC6371826 DOI: 10.5935/abc.20180256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background The Fontan-Kreutzer procedure (FK) was widely performed in the past, but in
the long-term generated many complications resulting in univentricular
circulation failure. The conversion to total cavopulmonary connection (TCPC)
is one of the options for treatment. Objective To evaluate the results of conversion from FK to TCPC. Methods A retrospective review of medical records for patients who underwent the
conversion of FK to TCPC in the period of 1985 to 2016. Significance p <
0,05. Results Fontan-type operations were performed in 420 patients during this period:
TCPC was performed in 320, lateral tunnel technique in 82, and FK in 18. Ten
cases from the FK group were elected to conversion to TCPC. All patients
submitted to Fontan Conversion were included in this study. In nine patients
the indication was due to uncontrolled arrhythmia and in one, due to
protein-losing enteropathy. Death was observed in the first two cases. The
average intensive care unit (ICU) length of stay (LOS) was 13 days, and the
average hospital LOS was 37 days. A functional class by New York Heart
Association (NYHA) improvement was observed in 80% of the patients in NYHA I
or II. Fifty-seven percent of conversions due to arrhythmias had improvement
of arrhythmias; four cases are cured. Conclusions The conversion is a complex procedure and requires an experienced tertiary
hospital to be performed. The conversion has improved the NYHA functional
class despite an unsatisfactory resolution of the arrhythmia.
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Affiliation(s)
- Gabriel Carmona Fernandes
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Guilherme Viotto Rodrigues da Silva
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Luiz Fernando Caneo
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Carla Tanamati
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Aida Luiza Ribeiro Turquetto
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Marcelo Biscegli Jatene
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Miana LA, Silva GVRD, Caneo LF, Turquetto AL, Tanamati C, Foronda G, Massoti MR, Penha JG, Azeka E, Galas FRBG, Jatene FB, Jatene MB. Rational Use of Mechanical Circulatory Support as a Bridge to Pediatric and Congenital Heart Transplantation. Braz J Cardiovasc Surg 2018; 33:242-249. [PMID: 30043916 PMCID: PMC6089136 DOI: 10.21470/1678-9741-2018-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 11/12/2022] Open
Abstract
Introduction Donor shortage and organ allocation is the main problem in pediatric heart
transplant. Mechanical circulatory support is known to increase waiting list
survival, but it is not routinely used in pediatric programs in Latin
America. Methods All patients listed for heart transplant and supported by a mechanical
circulatory support between January 2012 and March 2016 were included in
this retrospective single-center study. The endpoints were mechanical
circulatory support time, complications, heart transplant survival and
discharge from the hospital. Results Twenty-nine patients from our waiting list were assessed. Twelve (45%)
patients were initially supported by extracorporeal membrane oxygenation
(ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five
patients initially supported by ECMO were bridged to another device. One was
bridged to a centrifugal pump and four were bridged to Berlin Heart
Excor®. Among the 29 supported patients, 18 (62%) managed to have a
heart transplant. Thirty-day survival period after heart transplant was 56%
(10 patients). Median support duration was 12 days (interquartile range
[IQR] 4 - 26 days) per run and the waiting time for heart transplant was 9.5
days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality
predictor (OR=22.6 [CI=1.04-494.6]; P=0.04). Conclusion Mechanical circulatory support was able to bridge most INTERMACS 1 and 2
pediatric patients to transplant with an acceptable complication rate. Acute
renal failure increased mortality after mechanical circulatory support in
our experience.
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Affiliation(s)
- Leonardo A Miana
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Guilherme Viotto Rodrigues da Silva
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Fernando Caneo
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Aida Luisa Turquetto
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Carla Tanamati
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Gustavo Foronda
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Maria Raquel Massoti
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Juliano G Penha
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Estela Azeka
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Filomena R B G Galas
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Marcelo B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Caneo LF, Turquetto ALR, Neirotti RA, Binotto MA, Miana LA, Tanamati C, Penha JG, Silveira JBD, Alexandre e Silva TM, Jatene FB, Jatene MB. Lessons Learned From a Critical Analysis of the Fontan Operation Over Three Decades in a Single Institution. World J Pediatr Congenit Heart Surg 2017; 8:376-384. [DOI: 10.1177/2150135117701405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The Fontan operation (FO) has evolved and many centers have demonstrated improved results relative to those from earlier eras. We report a single-institution experience over three decades, describing the outcomes and evaluating risk factors. Methods: Successive patients undergoing primary FO were divided into era I (1984-1994), era II (1995-2004), and era III (2005-2014). Clinical and operative notes were reviewed for demographic, anatomic, and procedure details. End points included early and late mortality and a composite of death, heart transplantation (HTX), or Fontan takedown. Results: A total of 420 patients underwent 18 atriopulmonary connections, 82 lateral tunnels (LT), and 320 extracardiac conduit (EC) Fontan procedures. Forty-six (11%) patients died; early and late mortality were 7.9% and 3.1%, respectively. Eight (1.9%) patients underwent HTX, 11 (2.6%) underwent Fontan conversion to EC, and 1 (0.2%) takedown of EC to bidirectional Glenn shunt. Prevalence of concomitant valve surgery ( P < .001) and pulmonary artery reconstruction ( P < .001) differed over the eras. Preoperative valve regurgitation was associated with likelihood of early mortality (odds ratio [OR] = 3.5, P = .002). Embolic events (OR = 1.9, P = .047), preoperative valve regurgitation (OR = 2.3, P = .029), diagnosis of unbalanced atrioventricular canal defect (OR = 1.14, P = .03), and concomitant valve replacement (OR = 6.9, P = .001) during the FO were associated with increased risk of the composite end point (death, HTX, or takedown). Conclusion: Technical modifications did not result in improved results across eras, due in part to more liberal indications for surgery in the recent years. Valve regurgitation, unbalanced atrioventricular canal, embolic events, or concomitant valve replacement were associated with FO failure.
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Affiliation(s)
- Luiz Fernando Caneo
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Aida L. R. Turquetto
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rodolfo A. Neirotti
- Surgery and Pediatrics, Emeritus Michigan State University, East Lansing, MI, USA
| | - Maria A. Binotto
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo A. Miana
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carla Tanamati
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Juliano G. Penha
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - João B. D. Silveira
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Fabio B. Jatene
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo B. Jatene
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Miana LA, Canêo LF, Tanamati C, Penha JG, Guimarães VA, Miura N, Galas FRBG, Jatene MB. Post-cardiotomy ECMO in pediatric and congenital heart surgery: impact of team training and equipment in the results. Braz J Cardiovasc Surg 2016; 30:409-16. [PMID: 27163414 PMCID: PMC4614923 DOI: 10.5935/1678-9741.20150053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/27/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Post-cardiotomy myocardial dysfunction requiring mechanical circulatory
support occurs in about 0.5% of cases. In our environment, the use of
extracorporeal membrane oxygenation has been increasing in recent years. Objective To evaluate the impact of investment in professional training and improvement
of equipment in the rate of weaning from extracorporeal membrane oxygenation
and survival. Methods A retrospective study. Fifty-six pediatric and/or congenital heart patients
underwent post-cardiotomy extracorporeal membrane oxygenation at our
institution between November 1999 and July 2014. We divided this period into
two phases: phase I, 36 cases (before the structuring of the extracorporeal
membrane oxygenation program) and phase II, 20 cases (after the
extracorporeal membrane oxygenation program implementation) with investment
in training and equipment). Were considered as primary outcomes:
extracorporeal membrane oxygenation weaning and survival to hospital
discharge. The results in both phases were compared using Chi-square test.
To identify the impact of the different variables we used binary logistic
regression analysis. Results Groups were comparable. In phase I, 9 patients (25%) were weaned from
extracorporeal membrane oxygenation, but only 2 (5.5%) were discharged. In
phase II, extracorporeal membrane oxygenation was used in 20 patients,
weaning was possible in 17 (85%), with 9 (45%) hospital discharges
(P<0.01). When the impact of several variables on
discharge and weaning of extracorporeal membrane oxygenation was analyzed,
we observe that phase II was an independent predictor of better results
(P<0.001) and need for left cavities drainage was
associated with worse survival (P=0.045). Conclusion The investment in professional training and improvement of equipment
significantly increased extracorporeal membrane oxygenation results.
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Affiliation(s)
| | - Luiz Fernando Canêo
- Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Carla Tanamati
- Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Juliano Gomes Penha
- Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | | | - Nana Miura
- Clinics Hospital, Medical School, University of São Paulo, São Paulo, SP, Brazil
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Penha JGD, Zorzanelli L, Barbosa-Lopes AA, Atik E, Miana LA, Tanamati C, Caneo LF, Miura N, Aiello VD, Jatene MB. Palliative Senning in the Treatment of Congenital Heart Disease with Severe Pulmonary Hypertension. Arq Bras Cardiol 2015; 105:353-61. [PMID: 26559982 PMCID: PMC4632999 DOI: 10.5935/abc.20150097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/18/2015] [Indexed: 11/20/2022] Open
Abstract
Background Transposition of the great arteries (TGA) is the most common cyanotic cardiopathy,
with an incidence ranging between 0.2 and 0.4 per 1000 live births. Many patients
not treated in the first few months of life may progress with severe pulmonary
vascular disease. Treatment of these patients may include palliative surgery to
redirect the flow at the atrial level. Objective Report our institutional experience with the palliative Senning procedure in
children diagnosed with TGA and double outlet right ventricle with severe
pulmonary vascular disease, and to evaluate the early and late clinical
progression of the palliative Senning procedure. Methods Retrospective study based on the evaluation of medical records in the period of
1991 to 2014. Only patients without an indication for definitive surgical
treatment of the cardiopathy due to elevated pulmonary pressure were included. Results After one year of follow-up there was a mean increase in arterial oxygen
saturation from 62.1% to 92.5% and a mean decrease in hematocrit from 49.4% to
36.3%. Lung histological analysis was feasible in 16 patients. In 8 patients,
pulmonary biopsy grades 3 and 4 were evidenced. Conclusion The palliative Senning procedure improved arterial oxygen saturation, reduced
polycythemia, and provided a better quality of life for patients with TGA with
ventricular septal defect, severe pulmonary hypertension, and poor prognosis.
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Affiliation(s)
- Juliano Gomes da Penha
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leina Zorzanelli
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Edimar Atik
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leonardo Augusto Miana
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carla Tanamati
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Fernando Caneo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nana Miura
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Miana LA, Azeka E, Canêo LF, Turquetto AL, Tanamati C, Penha JG, Cauduro A, Jatene MB. Pediatric and congenital heart transplant: twenty-year experience in a tertiary Brazilian hospital. Braz J Cardiovasc Surg 2015; 29:322-9. [PMID: 25372904 PMCID: PMC4412320 DOI: 10.5935/1678-9741.20140106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 07/10/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Cardiac transplantation remains the gold standard for end-stage cardiomyopathies and congenital heart defects in pediatric patients. OBJECTIVE This study aims to report on 20 years of experience since the first case and evaluate our results. METHODS We conducted a retrospective analysis of the database and outpatient follow-up. Between October 1992 and April 2012, 109 patients underwent 114 transplants. 51.8% of them being female. The age of patients ranged from 12 days to 21 years with a mean of 8.8±5.7 years and a median of 5.2 years. The underlying diagnosis was dilated cardiomyopathy in 61.5%, congenital heart disease in 26.6% and restrictive cardiomyopathy in 11.9%. All patients above 17 years old had congenital heart disease. RESULTS Survival rate at 30 days, 1, 5, 10, 15, and 20 years were 90.4%, 81.3%, 70.9%, 60.5%, 44.4% and 26.7%, respectively. Mean cold ischemic time was 187.9 minutes and it did not correlate with mortality (P>0.05). Infectious complications and rejection episodes were the most common complications (P<0.0001), occurring, respectively, in 66% and 57.4% of the survivors after 10 years. There was no incidence of graft vascular disease and lymphoproliferative disease at year one, but they affected, respectively, 7.4% and 11% of patients within 10 years. CONCLUSION Twenty-year pediatric heart transplant results at our institution were quite satisfactory and complication rates were acceptable.
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Affiliation(s)
- Leonardo Augusto Miana
- InCor, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Estela Azeka
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Fernando Canêo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aída Luisa Turquetto
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carla Tanamati
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliano Gomes Penha
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alexandre Cauduro
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Canêo LF, Miana LA, Tanamati C, Penha JG, Shimoda MS, Azeka E, Miura N, Galas FRBG, Guimarães VA, Jatene MB. Use of short-term circulatory support as a bridge in pediatric heart transplantation. Arq Bras Cardiol 2014; 104:78-84. [PMID: 25372474 PMCID: PMC4387614 DOI: 10.5935/abc.20140165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/25/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Heart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure. OBJECTIVE To evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy. METHODS Retrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy. RESULTS We used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n=10), eight died waiting and 2 patients (20%) were transplanted, but none was discharged. In group B (n=9), 6 patients (66.7%) were transplanted and three were discharged.The mean support time was 21,8 days (6 to 984 h). The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and cause of death in group A while neurologic complications were more prevalent en group B. CONCLUSION Mechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.
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Affiliation(s)
- Luiz Fernando Canêo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leonardo Augusto Miana
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carla Tanamati
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliano Gomes Penha
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Monica Satsuki Shimoda
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Estela Azeka
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nana Miura
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Vanessa Alves Guimarães
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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14
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Azeka E, Jatene M, Galas FRB, Tanamati C, Penha J, Benvenuti L, Miura N, Junior JOC. Heart transplantation in pediatric population and in adults with congenital heart disease: long-term follow-up, critical clinical analysis, and perspective for the future. Transplant Proc 2014; 46:1842-4. [PMID: 25131050 DOI: 10.1016/j.transproceed.2014.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Heart transplantation is a treatment option for children as well as for adults with congenital heart disease. OBJECTIVE To report the experience of a tertiary center with heart transplant program in pediatric population and in adults with congenital heart disease. PATIENTS AND METHODS The study consisted of the evaluation of pediatric as well as adult patients undergoing heart transplantation for congenital heart disease. We evaluated the following indication and complications such as renal dialysis, graft vascular disease, tumors and survival. RESULTS From October 1992 to November 2013, 134 patients had transplantation, and there were 139 transplantations and 5 retransplantations. The immunosuppression regimen is based on calcineurin inhibitors and cytostatic drugs. The type of heart disease indicated for transplantation was cardiomyopathies in 70% and congenital heart disease in 30%. Of these 134 patients, 85 patients were alive. Actuarial survival is 77.4%, 69.6%, 59.3% at 1, 5, and 10 years after transplantation. Three patients underwent renal transplantation, 1 patient is in renal dialysis, and 8.2% of patients had post-transplant lymphoproliferative disease. Two patients had retransplantation for graft vascular disease; 1 of them required a simultaneous kidney transplant and died 30 days after the procedure and 1 patient is clinically well 2 years after retransplantation. CONCLUSION Heart transplantation in children and in adults with congenital heart disease is a promising therapeutic option and enables long-term survival for these patients.
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Affiliation(s)
- E Azeka
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil.
| | - M Jatene
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
| | - F R B Galas
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
| | - C Tanamati
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
| | - J Penha
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
| | - L Benvenuti
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
| | - N Miura
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
| | - J O C Junior
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
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Liguori G, Camargo T, Akerman D, Penha J, Miana L, Caneo L, Tanamati C, Jatene M. Short-term results of the Warden technique: a retrospective single-center study. J Cardiothorac Surg 2013. [PMCID: PMC3846161 DOI: 10.1186/1749-8090-8-s1-p95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Liguori G, Penha J, Miana L, Caneo L, Tanamati C, Jatene M. 20-year experience with pediatric heart transplant in a developing country. J Cardiothorac Surg 2013. [PMCID: PMC3844650 DOI: 10.1186/1749-8090-8-s1-o309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Liguori G, Kanas A, Penha J, Miana L, Caneo L, Tanamati C, Jatene M. Valvar replacement in infants and preschool children: a retrospective single-center study. J Cardiothorac Surg 2013. [PMCID: PMC3844893 DOI: 10.1186/1749-8090-8-s1-p173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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18
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Penha JG, Zorzanelli L, Barbosa-Lopes AA, Aiello VD, Carvalho VO, Caneo LF, Riso ADA, Tanamati C, Atik E, Jatene MB. Heart Neoplasms in Children: Retrospective Analysis. Arq Bras Cardiol 2013; 100:120-6. [PMID: 23503820 DOI: 10.5935/abc.20130024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/05/2012] [Indexed: 11/20/2022] Open
Affiliation(s)
- Juliano Gomes Penha
- Instituto do Coração Unidade de Cirurgia Cardíaca Pediátrica, Hospital das Clínicas, FM, USP, São Paulo, SP, Brasil.
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Jatene MB, Celulari A, Miura N, Tanamati C, Carvalho VO, Marcial MB. Variant technique of extra-anatomic aortic bypass in aortic recoarctation. Arq Bras Cardiol 2012; 99:e149-51. [PMID: 23117558 DOI: 10.1590/s0066-782x2012001300018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Marcelo Biscegli Jatene
- Serviço de Cirurgia Cardíaca Pediátrica do Instituto do Coração do Hospital das Clínicas da Faculdade de medicina da USP, InCor-HCFMUSP, São Paulo, SP, Brasil.
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Caneo LF, Jatene MB, Riso AA, Tanamati C, Penha J, Moreira LF, Atik E, Trindade E, Stolf NAG. Avaliação do tratamento cirúrgico da cardiopatia congênita em pacientes com idade superior a 16 anos. Arq Bras Cardiol 2012; 98:390-7. [DOI: 10.1590/s0066-782x2012005000030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 01/03/2012] [Indexed: 11/21/2022] Open
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Cauduro A, Moreira L, Tanamati C, Caneo L, Penha J, Jatene M. 591 Waiting List Risk Factors in Pediatric Heart Transplant Center in the Developing Country. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Affiliation(s)
- Carla Tanamati
- Pediatric Cardiac Surgery at the Heart Institute, Clinical Hospital at the University of Sao Paulo Medical School.
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Jatene MB, Abuchaim DCS, Tiveron MG, Tanamati C, Miura N, Riso A, Atik E, Lopes AA, Marcial MB. Tratamento cirúrgico da persistência do canal arterial na população adulta. Braz J Cardiovasc Surg 2011; 26:93-7. [DOI: 10.1590/s0102-76382011000100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 02/15/2011] [Indexed: 11/21/2022] Open
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Juaneda I, Tanamati C, Tavares GMP, Marcial MLB. Surgical treatment of pulmonary venous tunnel stenosis [corrected] after modified Senning procedure. Braz J Cardiovasc Surg 2011; 25:588-90. [PMID: 21340391 DOI: 10.1590/s0102-76382010000400025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/24/2010] [Indexed: 11/21/2022] Open
Abstract
A 13-year-old male was admitted to undergoing correction of a pulmonary venous baffle stenosis (PVBS) after a modified Senning procedure was performed by the age of five months. Recurrent Pulmonary congestion and pneumonia episodes were followed by echocardiography and cardiac catheterization that confirmed PVBS. Previous catheter balloon angioplasty was attempted, and a surgical revision was done under cardiopulmonary bypass. The bovine pericardial patch used for augmentation of the right atrium, retracted and calcified producing PVBS. Stenotic area was excised and enlargement was done with polytetrafluoroethylene membrane. Intraoperative transesophageal echocardiogram showed relief of stenosis.
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Affiliation(s)
- Ignacio Juaneda
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.
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Abuchaim DCS, Tanamati C, Jatene MB, Marcial MLB, Aiello VD. Dominância coronariana na síndrome da hipoplasia do coração esquerdo. Braz J Cardiovasc Surg 2011; 26:604-8. [PMID: 22358276 DOI: 10.5935/1678-9741.20110051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/27/2011] [Indexed: 11/20/2022] Open
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Sousa JSD, Tanamati C, Marcial MB, Stolf NAG. Tumor amorfo calcificado do coração. Braz J Cardiovasc Surg 2011; 26:500-3. [DOI: 10.5935/1678-9741.20110031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 04/05/2010] [Indexed: 11/20/2022] Open
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Jatene MB, Caneo LF, Tanamati C, Mulinari L, Nina VJDS. From the Australia's great barrier reef to the Brazil's arrecifes: building bridges of reflection. Braz J Cardiovasc Surg 2010; 25:X-XI. [PMID: 20563460 DOI: 10.1590/s0102-76382010000100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jatene MB, Abuchaim DCS, Oliveira JDL, Riso A, Tanamati C, Miura N, Lopes AA, Barbero-Marcial ML. Outcomes of aortic coarctation surgical treatment in adults. Braz J Cardiovasc Surg 2009; 24:346-53. [PMID: 20011882 DOI: 10.1590/s0102-76382009000400014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 06/05/2009] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe our experience in aortic coarctation surgery in adult patients by assessing the immediate and mid-term outcomes. METHODS From January 1987 to March 2000, 50 consecutive adult patients underwent surgery for correction of aortic coarctation, through left lateral thoracotomy. Of these, forty two (84%) patients presented high blood pressure, with mean systolic arterial pressure of 170.56 mmHg (125-220 mmHg). The mean of pressure gradient in the coarctation area was 51.4 mmHg (18-123 mmHg). Other associated surgical cardiovascular diseases were not treated in the same operative act, except in two cases of patent ductus arteriosus (PDA). Three different techniques were used: aortic coarctation resection with end-to-end anastomosis was performed in 20 (40%) patients, coarctation enlargement with bovine pericardial patch was performed in 22 (44%) patients and synthetic tube interposition was performed in eight (16%) patients. RESULTS Operative morbidity was low; there was one case of bleeding who required reoperation. The most common immediate postoperative event was high blood pressure (98%), but it was easily controlled by intravenous drugs. There was no hospital death. Mean residual pressure gradient was 18.7 (8-33 mmHg). Patients were discharged in 9.5 days (5-30). Postoperative follow-up mean was 46.8 months (1-145 months) in 45 (91.8%) patients. Forty one (91.1%) of these followed-up patients had normal blood pressure, whereas 75.6% of them without drugs intake. 93.3% of these followed-up patients were asymptomatic. Four of them required further surgical operation, one needed a pacemaker implant, other two patients needed a cardiac valve replacement and one had endocarditis. There was one related death due to sepsis secondary to endocarditis. CONCLUSION Surgical treatment of aortic coarctation, even in adult patients, is an efficient therapeutic choice, regardless of the applied surgical technique, with low morbidity and mortality. It reduces efficiently the arterial pressure levels in both immediate and mid-term follow-up.
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Affiliation(s)
- Marcelo Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
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Jatene MB, Miana LA, Pessoa AJ, Riso A, Azeka E, Tanamati C, Gimenez S, Lopes AA, Marcial MB, Stolf NAG. Pediatric heart transplantation in refractory cardiogenic shock: a critical analysis of feasibility, applicability and results. Arq Bras Cardiol 2009; 90:329-33. [PMID: 18516404 DOI: 10.1590/s0066-782x2008000500010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 10/17/2007] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In children with dilated cardiomyopathy who are on the waiting list for heart transplantation, we evaluate the seriousness of their hemodynamic conditions. Some develop cardiogenic shock, and the mortality rate is high. Even with inotropic and respiratory support, heart transplantation is considered an extremely grave circumstance. OBJECTIVE The objective of this study is to report on our experience with children in this condition, in an attempt to analyze the viability, applicability and results of heart transplantation in these children. METHODS From March 2001 to February 2004, 22 children with dilated cardiomyopathy who were on the waiting list for heart transplantation developed cardiogenic shock, requiring transfer to pediatric intensive care unit (ICU), intubation and inotropic support. Their ages ranged from 11 months to 11 years (mean age: 4.3 years), 55% were males, 14 could be listed as clinical priority, and the remaining 8 were removed from the waiting list due to their unfavorable clinical conditions. RESULTS Eight heart transplantations were performed, and 6 children died while on the waiting list (42.9%). Two children died (25%) after transplantation and the remaining 6 were discharged from hospital in good clinical condition. The two main complications were organ rejection in 4 cases and infection in 5 cases. Two patients developed neurological complications, and one of them fully recovered. CONCLUSION Children with cardiomyopathy and cardiogenic shock require immediate heart transplantation; only 57.1% could be transplanted, with an early 25% mortality rate. Those who survived transplantation showed good clinical progress, similar to that of children transplanted on an elective basis.
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Affiliation(s)
- Marcelo Biscegli Jatene
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil.
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Sylos CD, Azeka E, Kajita L, Benvenutti L, Strunz CC, Branco KC, Riso AA, Tanamati C, Jatene M, Barbero-Marcial M. Avaliação do peptídeo natriurético tipo B no diagnóstico de rejeição após transplante cardíaco pediátrico. Arq Bras Cardiol 2009; 92:215-26. [DOI: 10.1590/s0066-782x2009000300011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 07/31/2008] [Indexed: 11/22/2022] Open
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Barbosa NDF, Azeka E, Aiello VD, Viana F, Jatene M, Tanamati C, Marcial MB. Isolated left ventricular noncompaction: unusual cause of decompensated heart failure and indication of heart transplantation in the early infancy--case report and literature review. Clinics (Sao Paulo) 2008; 63:136-9. [PMID: 18297218 PMCID: PMC2664197 DOI: 10.1590/s1807-59322008000100022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Atik E, Tanamati C, Barbero-Marcial M. Atrial septal defect with intermittent hypoxia due to venous return through a persistent left superior vena cava return draining into a contiguous coronary sinus. Case report. Rev Port Cardiol 2007; 26:1289-1296. [PMID: 18297844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
A case is reported of a 38-month-old female patient with an ostium secundum-type atrial septal defect, 25 mm in diameter, with intermittent hypoxemia and hypoplasia of the right ventricular cavity and tricuspid valve The right-to-left shunt through the atrial septal defect, responsible for these alterations, is explained by its proximity to the coronary sinus, and exacerbated by a persistent left superior vena cava. The cyanosis disappeared and normal hemodynamic status was achieved after closure of the atrial septal defect.
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Affiliation(s)
- Edmar Atik
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.
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Atik E, Tanamati C, Barbero-Marcial M. Atrial septal defect with intermittent hypoxia due to venous return through a persistent left superior vena cava return draining into a contiguous coronary sinus. Case report. Rev Port Cardiol 2007; 26:759-766. [PMID: 17939585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
A case is reported of a 38-month-old female patient with an ostium secundum-type atrial septal defect, 25 mm in diameter, with intermittent hypoxemia and hypoplasia of the right ventricular cavity and tricuspid valve. The right-to-left shunt through the atrial septal defect, responsible for these alterations, is explained by its proximity to the coronary sinus, and exacerbated by a persistent left superior vena cava. The cyanosis disappeared and normal hemodynamic status was achieved after closure of the atrial septal defect.
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Affiliation(s)
- Edmar Atik
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.
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Atik E, Tanamati C, Kajita L, Barbero-Marcial M. Isolated unilateral pulmonary artery agenesis: evaluation of natural and long term evolution after corrective surgery. Arq Bras Cardiol 2007; 87:423-8. [PMID: 17128310 DOI: 10.1590/s0066-782x2006001700005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 11/11/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Unilateral pulmonary artery agenesis is an uncommon isolated anomaly and since 1978 only 119 cases have been reported. In general the condition presents as pulmonary hypertension (PH) in children and hemoptysis in adults. Interventions such as pulmonary artery reconstruction and lobectomies were performed in 17% of the cases. We analyzed four of these cases, two in natural evolution and two with late term PH regression after surgical correction. METHODS Three 22,10 and 35 month old male children and one 20 month old female child were included in the study. The 22 month old presented right-sided heart failure (RHF) and cyanosis; the 10 month old presented RHF and the other two presented exertion fatigue. All had PH symptoms, right ventricular strain on the EKG and cardiomegaly. Cardiac catheterization showed systemic pressures in the contralateral pulmonary artery, with right-sided agenesis in three of the children and left-sided agenesis in one child. RESULTS Surgical correction of pulmonary artery continuity was possible in the 22 month old and 10 month old using a 7 mm diameter Goretex conduit between the pulmonary arteries up to the hypoplastic contralateral pulmonary hilum. There was early and late regression of the PH signs and the children remained stable during follow-up to the ages of 7 and 2.5 years, respectively. The pressure ratio between the left and right ventricles was 30 and 40%, in both cases. Pulmonary perfusion increased from 8 to 44% and from 8 to 23%, in the two cases. The same procedure was scheduled for the other patients. CONCLUSION This technique has become the operation of choice for similar cases, that are rarely described in literature, even in the presence of severe PH and contralateral pulmonary artery hypoplasia.
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Affiliation(s)
- Edmar Atik
- Instituto do Coração, Hospital das Clínicas, FM, USP, São Paulo, SP, Brazil.
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Tanamati C, Suguimoto RL, Atik E, Copolla SG, Galles FR, Aiello VD, Barbero-Marcial ML. Complete repair in total atrioventricular canal defect with cyanosis. Arq Bras Cardiol 2006; 87:e1-3. [PMID: 17057907 DOI: 10.1590/s0066-782x2006001600025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 08/22/2005] [Indexed: 11/21/2022] Open
Abstract
Atrioventricular septal defects account for 4% of congenital cardiac malformations and over 50% of cardiac defects seen in Down syndrome. Clinical presentation is marked by congestive heart failure early in infancy. Cyanosis is rarely found in infants and suggests irreversible pulmonary hypertension or associated cardiac defects as tetralogy of Fallot, double outlet right ventricle, Ebstein anomaly, persistent left superior vena cava draining in the left atrium (Barbero Marcial, personal communication). Children with Down's syndrome is particularly difficult to assess because they often suffer from upper airways obstruction, which may contribute to the increased pulmonary vascular resistance determined at cardiac catheterization. This association of factors becomes a challenge for operability and, we will report one such case.
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Affiliation(s)
- Carla Tanamati
- Instituto do Coração, Hospital das Clínicas, FMUSP, São Paulo, SP.
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Jatene MB, Azeka E, Atik E, Riso A, Tanamati C, Marcial MB, de Oliveira SA. Ascending Aortic Aneurysm After Pediatric Heart Transplantation: Case Report of an Unusual Complication. J Heart Lung Transplant 2005; 24:638-41. [PMID: 15896768 DOI: 10.1016/j.healun.2004.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2002] [Revised: 02/03/2004] [Accepted: 03/01/2004] [Indexed: 11/20/2022] Open
Abstract
A 28-month-old boy, weighing 11 kg, with severe dilated cardiomyopathy, was transplanted on December 1995. Hypertension and supraventricular tachycardia were detected in the immediate post-operative period, with favorable outcome. After 5 months of clinically asymptomatic follow-up, a dilation in the ascending aorta was observed on routine echocardiogram. Nuclear magnetic resonance imaging (NMRI) confirmed an ascending aortic aneurysm, with a diameter of 38 mm. An operation was performed, a bovine pericardium patch was sutured with reconstruction of the aortic wall, excluding the aneurysm. Good recovery was obtained and the child was discharged on Day 7 postoperatively. A post-operative echocardiogram showed absence of the aortic aneurysm and good surgical results. Another NMRI was done 5 months later, showing an intact ascending aorta. After 64 months, the patients clinical condition was confirmed as normal by echocardiogram. Surgical treatment was successful and the positive results have been maintained.
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Tanamati C, Monachini M, Cantarelli M, Khouri P, Amarante G, Martins P, Coelho F, Schettino G. Crit Care 2005; 9:P10. [DOI: 10.1186/cc3554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Croti UA, Marcial MLB, Tanamati C, Jatene MB, Braile DM, de Oliveira SA. Avaliação do suprimento sangüíneo vascular pulmonar nos portadores de atresia pulmonar com comunicação interventricular e artérias colaterais sistêmico-pulmonares. Arq Bras Cardiol 2005; 84:3-9. [PMID: 15841837 DOI: 10.1590/s0066-782x2005000100002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Riso A, Barbero-Marcial M, Tanamati C, Jatene MB, Oliveira SA. Repair of Atrioventricular Septal Defect (AVSD) associated with Tetralogy of Fallot (TOF). Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Croti UA, Barbero Marcial ML, Tanamati C, Jatene MB, Oliveira SAD. The pulmonary vascular blood supply in the pulmonary atresia with ventricular septal defect and its implications in surgical treatment. Braz J Cardiovasc Surg 2003. [DOI: 10.1590/s0102-76382003000100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Barbero-Marcial M, Tanamati C. Alternative nonvalved techniques for repair of truncus arteriosus: Long-term results. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001; 2:121-130. [PMID: 11486231 DOI: 10.1016/s1092-9126(99)70011-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Primary early repair has been advocated as the preferred surgical approach to truncus arteriosus in infancy. This approach usually includes the reconstruction of the right ventricle outflow tract using a valved extracardiac conduit. However, the longevity of these conduits and the risk of their replacement have been a subject of major concern. When used in early infancy, these conduits require repeated replacement because of internal obstruction or because the patient has outgrown the conduit. Our group first described the possibility of correction without an extracardiac conduit in 1990, although it has been performed at our institution since 1987. The ideal candidates for this type of correction include patients up to 5 months of age who have truncus arteriosus type I or II (Colllet-Edwards classification), no anomalous trajectory of the coronary artery crossing anteriorly to the truncus, and no significant pulmonary vascular resistance (pulmonary vascular resistance <7 Wood units). This surgical technique is described and the outcomes reviewed. Copyright 1999 by W.B. Saunders Company
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Affiliation(s)
- Miguel Barbero-Marcial
- Pediatric Cardiac Surgery Department, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
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Amaral F, Tanamati C, Granzotti JA, Haddad JL, Leite JR, Barbero-Marcial M. Congenital atresia of the ostium of the left coronary artery. Diagnostic difficulty and successful surgical revascularization in two patients. Arq Bras Cardiol 2000; 74:339-42. [PMID: 10967586 DOI: 10.1590/s0066-782x2000000400005] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report two cases of congenital atresia of the ostium of the left coronary artery. Case 1: a six-month-old infant presenting with serious cardiac insufficiency. A noninvasive diagnosis of dilated myocardiopathy was established and the clinical picture was pharmacologically compensated. When the patient was nine months of age, a hemodynamic study was performed that revealed congenital atresia of the ostium of the left coronary artery; the infant immediately underwent a successful anastomosis of the internal mammary artery with the left coronary artery. Case 2: an eleven-year-old asymptomatic boy with a history of heart murmur from the age of six months on, was referred for surgery with a diagnosis of anomalous origin of the left coronary artery from pulmonary trunk. A definitive diagnosis of atresia of the left coronary ostium was only established during surgery. Successful surgical revascularization with the left internal mammary artery, and left ventricular aneurysmectomy were performed.
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Affiliation(s)
- F Amaral
- Hospital do Coraao de Ribeirão Preto/ Fundação Waldemar B. Pessoa, USP
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Barbero-Marcial M, Tanamati C, Atik E, Ebaid M. Intraventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect: advantages of multiple patches. J Thorac Cardiovasc Surg 1999; 118:1056-67. [PMID: 10595979 DOI: 10.1016/s0022-5223(99)70102-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this paper is to report our experience with biventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect by means of multiple patches that simplify and render feasible the intraventricular correction of this complex anomaly. METHODS From April 1987 to April 1999, in 18 patients with double-outlet right ventricle and noncommitted ventricular septal defect, a technical modification that used multiple patches of bovine pericardium was used to construct an intraventricular tunnel connecting the left ventricle to the aorta. Ages ranged from 2 months to 13 years (mean age 4.73 +/- 3.41 years). RESULTS The early mortality was of 11.1% (2 patients). Surviving patients were followed up for a mean of 2.65 years. Three late deaths (16.6%) occurred: 5 months, 7 months, and 7 months after the operation. All but 1 patient are in New York Heart Association class I. CONCLUSION The use of multiple patches for biventricular correction of this anomaly simplifies and renders feasible the intraventricular repair in cases in which the 1-patch technique was deemed impossible.
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Affiliation(s)
- M Barbero-Marcial
- Pediatric Cardiac Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
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Atik E, Barbero-Marcial M, Tanamati C, Kajita L, Ebaid M, Jatene A. Anomalous origin of the left coronary artery from the right pulmonary artery with intramural aortic trajectory. Clinicosurgical diagnostic implications. Arq Bras Cardiol 1999; 73:181-90. [PMID: 10752187 DOI: 10.1590/s0066-782x1999000800006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Anomalous origin of the left coronary artery from the right pulmonary artery (AOLCARPA), is a rare entity that is usually associated with other defects. Of the 20 cases of AOLCARPA reported in the literature, 14 (70%) had associations. We describe four patients with AOLCARPA without associated defects, but with a peculiar intramural aortic trajectory. METHODS Fifty-five patients with anomalous origin of the left coronary artery were operated upon at INCORFMUSP. Four of the patients had the anomalous origin from the right pulmonary artery (RPA) without associated defects but with intramural aortic trajectory. Clinical and laboratory examinations were analyzed, as well as surgical findings. RESULTS All patients had congestive heart failure (CHF) and 3 also had angina pectoris. Two patients had a murmur of mitral regurgitation, signs of myocardial infarction on the ECG and cardiomegaly. The shortening fraction varied from 9% to 23%. The hemodynamic study confirmed the diagnosis of anomalous origin of the coronary artery, but the intramural trajectory and the origin from the RPA were established only at surgery. In 3 patients, the technique of side-to-side anastomosis was performed with a good outcome. One patient, who underwent end-to-side anastomosis, died 6 months after the surgery. CONCLUSION Association with other defects usually occurs in the AOLCARPA, and the intramural aortic trajectory is difficult to clinically diagnose but easy to surgically correct.
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Affiliation(s)
- E Atik
- Instituto do Coração do Hospital das Clínicas, FMUSP, Brazil
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Barbero-Marcial M, Tanamati C, Atik E, Ebaid M, Jatene A. Anomalous origin of the left coronary artery from the pulmonary artery with intramural aortic route: diagnosis and surgical treatment. J Thorac Cardiovasc Surg 1999; 117:823-5. [PMID: 10096981 DOI: 10.1016/s0022-5223(99)70306-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Barbero-Marcial
- Departments of Cardiothoracic Surgery, Cardiology, Pediatric Cardiology, and Cardiac Surgery, Heart Institute University of São Paulo Medical School and Hospital, Sírio Libanês, São Paulo, Brazil
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Barbero-Marcial ML, Tanamati C. Repair of truncus arteriosus. Adv Card Surg 1999; 10:43-73. [PMID: 9917900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Abstract
BACKGROUND Interest in minimally invasive procedures has recently increased because it results in less surgical trauma, decreased patient discomfort, short hospital stay, reduced costs, and better cosmetic appearance. Based on these facts, we have been using the transxiphoid process approach without sternotomy for the correction of atrial septal defects. METHODS From July 1996 to January 1997, the xiphoid process window approach was performed in 10 patients with ostium secundum atrial septal defect. Ages ranged from 6 months to 14 years (mean, 5.3 years). In all patients, extracorporeal circulation was carried out by means of cannulation of the femoral artery and both caval veins and of aortic cross-clamping. Videothoracoscopy was used to improve visualization of the aorta. RESULTS There were no intraoperative or postoperative complications, and in all but 1 patient, extubation was possible while in the operating room. CONCLUSIONS The xiphoid process window, with no median sternotomy, permitted closure of the atrial septal defects with good results and could be used as a less invasive technique for their correction.
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Affiliation(s)
- M Barbero-Marcial
- Heart Institute, University of São Paulo Medical School, Hospital Sírio Libanês, Brazil
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Barbero-Marcial M, Jatene MB, Tanamati C, Ikari NM, Atik E, Ebaid M, Verginelli G, Jatene AD. Abordagem transxifóidea sem esternotomia para correção da comunicação interatrial. Braz J Cardiovasc Surg 1996. [DOI: 10.1590/s0102-76381996000400011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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