1
|
Benvenuti LA, Gutierrez PS, Aiello VD. Myocarditis, histological detection and parasitic load of Trypanosoma cruzi in endomyocardial biopsies presenting with reactivation of Chagas disease after heart transplantation. Transpl Infect Dis 2023; 25:e14185. [PMID: 37864502 DOI: 10.1111/tid.14185] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Luiz A Benvenuti
- Department of Pathology, Instituto do Coraçao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo S Gutierrez
- Department of Pathology, Instituto do Coraçao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vera D Aiello
- Department of Pathology, Instituto do Coraçao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
2
|
Chokr MO, Pinto Vandoni PM, de Carvalho Neto JN, de Moura LG, Dos Santos Sousa IB, Aiello VD, de Brito FS, Pisani CF, Hardy CA, de Melo SL, Darrieux FCC, Hachul DT, Scanavacca MI. Feasibility of Transatrial Access for Epicardial Ablation: Evaluation of 2 Different Techniques in Swine. JACC Clin Electrophysiol 2023; 9:2315-2328. [PMID: 37676203 DOI: 10.1016/j.jacep.2023.07.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The subxiphoid pericardial access is technically difficult and has a considerable rate of complications, thus transatrial access may be an alternative. OBJECTIVES This study sought to assess the feasibility and safety of this strategy regarding periprocedural period and after 1-week follow-up. METHODS The investigators performed epicardial mapping through transatrial puncture in 20 swine. Animals were divided into group A, in which aspiration of the sheath was performed to maintain negative pressure after the withdraw of the catheters, and group B, in which a device (Konar-MF VSD Occluder) was delivered to occlude the right atrial appendage perforation. Bleeding was investigated immediately and 1 week after. RESULTS Access was safe in 19 of 20 animals (95%) with small amount of bleeding (6.4 ± 6 mL). In group A (n = 10), 1 animal presented hemopericardium right after the puncture. In the other 9, epicardial ablation was performed and 60.0 ± 28.0 mL of blood was aspirated without events. After 1 week, fibrin-hemorrhagic pericarditis was identified in 3 animals. In group B (n = 10), reaching the epicardial surface was possible in all animals. An adequate position of the prosthesis was obtained in 90% (9 of 10). One death occurred in the immediate postoperative period, secondary to pneumothorax. After 1 week, postmortem analysis showed absence of pericardial bleeding and a normal-appearing pericardium in the 8 animals with adequate prosthesis position. CONCLUSIONS Transatrial access allows epicardial mapping and ablation. Sheath removal after negative pressure contributes to achieving acute bleeding control but does not prevent its occurrence. The use of the device prevents bleeding and hemorrhagic pericarditis.
Collapse
Affiliation(s)
- Muhieddine O Chokr
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | | | | | - Lucas G de Moura
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Vera D Aiello
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Sandoli de Brito
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Cristiano F Pisani
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carina A Hardy
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sissy L de Melo
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Francisco C C Darrieux
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Denise T Hachul
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mauricio I Scanavacca
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
3
|
Tretter JT, Spicer DE, Franklin RCG, Béland MJ, Aiello VD, Cook AC, Crucean A, Loomba RS, Yoo SJ, Quintessenza JA, Tchervenkov CI, Jacobs JP, Najm HK, Anderson RH. Expert Consensus Statement: Anatomy, Imaging, and Nomenclature of Congenital Aortic Root Malformations. Cardiol Young 2023; 33:1060-1068. [PMID: 37288941 DOI: 10.1017/s1047951123001233] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Over the past 2 decades, several categorizations have been proposed for the abnormalities of the aortic root. These schemes have mostly been devoid of input from specialists of congenital cardiac disease. The aim of this review is to provide a classification, from the perspective of these specialists, based on an understanding of normal and abnormal morphogenesis and anatomy, with emphasis placed on the features of clinical and surgical relevance. We contend that the description of the congenitally malformed aortic root is simplified when approached in a fashion that recognizes the normal root to be made up of 3 leaflets, supported by their own sinuses, with the sinuses themselves separated by the interleaflet triangles. The malformed root, usually found in the setting of 3 sinuses, can also be found with 2 sinuses, and very rarely with 4 sinuses. This permits description of trisinuate, bisinuate, and quadrisinuate variants, respectively. This feature then provides the basis for classification of the anatomical and functional number of leaflets present. By offering standardized terms and definitions, we submit that our classification will be suitable for those working in all cardiac specialties, whether pediatric or adult. It is of equal value in the settings of acquired or congenital cardiac disease. Our recommendations will serve to amend and/or add to the existing International Paediatric and Congenital Cardiac Code, along with the Eleventh iteration of the International Classification of Diseases provided by the World Health Organization.
Collapse
Affiliation(s)
- Justin T Tretter
- Department of Pediatric Cardiology, Cleveland Clinic Children's and The Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida
| | - Rodney C G Franklin
- Paediatric Cardiology Department, Royal Brompton & Harefield National Health Service Trust, London, United Kingdom
| | - Marie J Béland
- Division of Pediatric Cardiology, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| | - Vera D Aiello
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Adrian Crucean
- Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Rohit S Loomba
- Division of Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Christo I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| | - Jeffrey P Jacobs
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida
| | - Hani K Najm
- Division of Pediatric Cardiac Surgery, Cleveland Clinic Children's and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert H Anderson
- Cardiovascular Research Centre, Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
4
|
Tretter JT, Spicer DE, Franklin RCG, Béland MJ, Aiello VD, Cook AC, Crucean A, Loomba RS, Yoo SJ, Quintessenza JA, Tchervenkov CI, Jacobs JP, Najm HK, Anderson RH. Expert Consensus Statement: Anatomy, Imaging, and Nomenclature of Congenital Aortic Root Malformations. Ann Thorac Surg 2023; 116:6-16. [PMID: 37294261 DOI: 10.1016/j.athoracsur.2023.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 12/21/2022] [Revised: 02/03/2023] [Accepted: 03/15/2023] [Indexed: 06/10/2023]
Abstract
Over the past 2 decades, several categorizations have been proposed for the abnormalities of the aortic root. These schemes have mostly been devoid of input from specialists of congenital cardiac disease. The aim of this review is to provide a classification, from the perspective of these specialists, based on an understanding of normal and abnormal morphogenesis and anatomy, with emphasis placed on the features of clinical and surgical relevance. We contend that the description of the congenitally malformed aortic root is simplified when approached in a fashion that recognizes the normal root to be made up of 3 leaflets, supported by their own sinuses, with the sinuses themselves separated by the interleaflet triangles. The malformed root, usually found in the setting of 3 sinuses, can also be found with 2 sinuses, and very rarely with 4 sinuses. This permits description of trisinuate, bisinuate, and quadrisinuate variants, respectively. This feature then provides the basis for classification of the anatomical and functional number of leaflets present. By offering standardized terms and definitions, we submit that our classification will be suitable for those working in all cardiac specialties, whether pediatric or adult. It is of equal value in the settings of acquired or congenital cardiac disease. Our recommendations will serve to amend and/or add to the existing International Paediatric and Congenital Cardiac Code, along with the Eleventh iteration of the International Classification of Diseases provided by the World Health Organization.
Collapse
Affiliation(s)
- Justin T Tretter
- Department of Pediatric Cardiology, Cleveland Clinic Children's and The Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida; Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida
| | - Rodney C G Franklin
- Paediatric Cardiology Department, Royal Brompton & Harefield National Health Service Trust, London, United Kingdom
| | - Marie J Béland
- Division of Pediatric Cardiology, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| | - Vera D Aiello
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Adrian Crucean
- Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Rohit S Loomba
- Division of Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Christo I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| | - Jeffrey P Jacobs
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida
| | - Hani K Najm
- Division of Pediatric Cardiac Surgery, Cleveland Clinic Children's and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert H Anderson
- Cardiovascular Research Centre, Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
5
|
Assad RS, Guedes MGA, Aiello VD, Thomaz PG, Zanoni FL, Saito M, da Silva APN, Coutinho E Silva RDS, Pinto MV, Jatene MB, Moreira LFP. Ischemic preconditioning does not prevent placental dysfunction induced by fetal cardiac bypass. J Card Surg 2022; 37:2592-2599. [PMID: 35775747 DOI: 10.1111/jocs.16718] [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] [Received: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Remote ischemic preconditioning (rIPC) has been applied to attenuate tissue injury. We tested the hypothesis that rIPC applied to fetal lambs undergoing cardiac bypass (CB) reduces fetal systemic inflammation and placental dysfunction. METHODS Eighteen fetal lambs were divided into three groups: sham, CB control, and CB rIPC. CB rIPC fetuses had a hindlimb tourniquet applied to occlude blood flow for four cycles of a 5-min period, followed by a 2-min reperfusion period. Both study groups underwent 30 min of normothermic CB. Fetal inflammatory markers, gas exchange, and placental and fetal lung morphological changes were assessed. RESULTS The CB rIPC group achieved higher bypass flow rates (p < .001). After CB start, both study groups developed significant decreases in PaO2 , mixed acidosis, and increased lactate levels (p < .0004). No significant differences in tissular edema were observed on fetal lungs and placenta (p > .391). Expression of Toll-like receptor 4 and intercellular adhesion molecule-1 in the placenta and fetal lungs did not differ among the three groups, as well as with vascular cell adhesion molecule-1 (VCAM-1) of fetal lungs (p > .225). Placental VCAM-1 expression was lower in the rIPC group (p < .05). Fetal interleukin-1 (IL-1) and thromboxane A2 (TXA2) levels were lower at 60 min post-CB in the CB rIPC group (p < .05). There were no significant differences in tumor necrosis factor-α, prostaglandin E2, IL-6, and IL-10 plasma levels of the three groups at 60-min post-bypass (p > .133). CONCLUSION Although rIPC allowed increased blood flow during fetal CB and decreased IL-1 and TXA2 levels and placental VCAM-1, it did not prevent placental dysfunction in fetal lambs undergoing CB.
Collapse
Affiliation(s)
- Renato S Assad
- Laboratory of Cardiovascular Research, Heart Institute University of São Paulo, São Paulo, Brazil
| | - Marcelo G A Guedes
- Laboratory of Cardiovascular Research, Heart Institute University of São Paulo, São Paulo, Brazil
| | - Vera D Aiello
- Division of Pathology, Heart Institute University of São Paulo, São Paulo, Brazil
| | - Petronio G Thomaz
- Laboratory of Cardiovascular Research, Heart Institute University of São Paulo, São Paulo, Brazil
| | - Fernando L Zanoni
- Laboratory of Cardiovascular Research, Heart Institute University of São Paulo, São Paulo, Brazil
| | - Mauricio Saito
- Laboratory of Cardiovascular Research, Heart Institute University of São Paulo, São Paulo, Brazil
| | - Ana Paula N da Silva
- Laboratory of Cardiovascular Research, Heart Institute University of São Paulo, São Paulo, Brazil
| | | | - Marcelo V Pinto
- Laboratory of Cardiovascular Research, Heart Institute University of São Paulo, São Paulo, Brazil
| | - Marcelo B Jatene
- Division of Pediatric Cardiac Surgery, Heart Institute University of São Paulo, São Paulo, Brazil
| | - Luiz Felipe P Moreira
- Laboratory of Cardiovascular Research, Heart Institute University of São Paulo, São Paulo, Brazil
| |
Collapse
|
6
|
Bernstein L, Ramier A, Wu J, Aiello VD, Béland MJ, Lin CP, Yun SH. Ultrahigh resolution spectral-domain optical coherence tomography using the 1000-1600 nm spectral band. Biomed Opt Express 2022; 13:1939-1947. [PMID: 35519264 PMCID: PMC9045918 DOI: 10.1364/boe.443654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/10/2023]
Abstract
Ultrahigh resolution optical coherence tomography (UHR-OCT) can image microscopic features that are not visible with the standard OCT resolution of 5-15 µm. In previous studies, high-speed UHR-OCT has been accomplished within the visible (VIS) and near-infrared (NIR-I) spectral ranges, specifically within 550-950 nm. Here, we present a spectral domain UHR-OCT system operating in a short-wavelength infrared (SWIR) range from 1000 to 1600 nm using a supercontinuum light source and an InGaAs-based spectrometer. We obtained an axial resolution of 2.6 µm in air, the highest ever recorded in the SWIR window to our knowledge, with deeper penetration into tissues than VIS or NIR-I light. We demonstrate imaging of conduction fibers of the left bundle branch in freshly excised porcine hearts. These results suggest a potential for deep-penetration, ultrahigh resolution OCT in intraoperative applications.
Collapse
Affiliation(s)
- Liane Bernstein
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street, Boston, MA 02140, USA,Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Antoine Ramier
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street, Boston, MA 02140, USA,Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jiamin Wu
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street, Boston, MA 02140, USA,Department of Automation, Tsinghua University, Beijing 100084, China,Institute for Brain and Cognitive Science, Tsinghua University, Beijing 100084, China
| | - Vera D. Aiello
- Laboratory of Pathology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Marie J. Béland
- Division of Pediatric Cardiology, The Montreal Children’s Hospital of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Charles P. Lin
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street, Boston, MA 02140, USA,Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Seok-Hyun Yun
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street, Boston, MA 02140, USA,Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA,Department of Dermatology, Harvard Medical School, Boston, MA, USA,
| |
Collapse
|
7
|
SantAnna JPC, Faria RR, Assad IP, Pinheiro CCG, Aiello VD, Albuquerque-Neto C, Bortolussi R, Cestari IA, Maizato MJS, Hernandez AJ, Bueno DF, Fernandes TL. Tissue Engineering and Cell Therapy for Cartilage Repair: Preclinical Evaluation Methods. Tissue Eng Part C Methods 2022; 28:73-82. [PMID: 35107353 DOI: 10.1089/ten.tec.2021.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/19/2022] Open
Abstract
A chondral injury is a limiting disease that can affect the quality of life and be an economic burden due to the cost of immediate treatment and loss in work productivity. If left untreated, such an injury may progress to osteoarthritis, a degenerative and debilitating joint disease characterized by pain and functional impairment. Mesenchymal stromal cells (MSCs), which have immune-modulatory properties and the ability to differentiate into chondroblasts and osteoblasts, are a predictable source for the treatment of cartilage injuries. This article presents tools to evaluate cartilage restoration by tissue engineering and cell therapy treatment in a translational and preclinical large animal model. In this controlled experimental study with 14 miniature pigs, a scaffold-free tissue engineering construct (TEC) derived from dental pulp and synovial MSCs for cartilage therapy was tested. Total thickness cartilage defects were performed in both posterior knees. The defect was left empty in one of the knees, and the other received the TEC. The tissue repair was morphologically assessed by magnetic resonance imaging (MRI) using the three-dimensional double echo steady-state (3D-DESS) sequence, and compositional assessment was carried out based on the T2 mapping technique. The osteochondral specimens were fixed for histopathology, decalcified, subjected to standard histological processing, sectioned, and stained with hematoxylin and eosin. The sections stained for immunohistochemical detection of collagen types were digested with pepsin and chondroitinase and incubated with antibodies against them. The mechanical evaluation involved analysis of Young's modulus of the cartilage samples based on the indentation and maximum compression test. In addition, a finite element model was used to simulate and characterize properties of the osteochondral block. At 6 months after surgery, there were no complications with the animals and the MRI, histological, immunohistochemical, and biomechanical evaluations proved to be effective and qualified to differentiate good quality chondral repair from inadequate repair tissue. The proposed methods were feasible and capable to properly evaluate the defect filled with TEC containing stromal cells after 6 months of follow-up in a large animal model for articular cartilage restoration. Impact Statement Articular chondral injuries are prevalent and represent an economic burden due to the cost of treatment. The engineering of cartilage tissue can promote the repair of chondral injuries and is dependent on selecting appropriate cells and biocompatible frameworks. In this article, methods for evaluation of a scaffold-free cell delivery system made from mesenchymal stromal cells were present in a translational study that allows further clinical safety and efficacy trials.
Collapse
Affiliation(s)
- João P C SantAnna
- Grupo de Medicina do Esporte, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rafaella R Faria
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isabella P Assad
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Vera D Aiello
- Laboratório de Patologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Cyro Albuquerque-Neto
- Department of Mechanical Engineering, Centro Universitário da FEI, São Paulo, Brazil
| | - Roberto Bortolussi
- Department of Mechanical Engineering, Centro Universitário da FEI, São Paulo, Brazil
| | - Idágene A Cestari
- Laboratório de Investigação Médica em Bioengenharia, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina J S Maizato
- Laboratório de Investigação Médica em Bioengenharia, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Arnaldo J Hernandez
- Grupo de Medicina do Esporte, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Tiago L Fernandes
- Grupo de Medicina do Esporte, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| |
Collapse
|
8
|
Jacobs JP, Franklin RCG, Béland MJ, Spicer DE, Colan SD, Walters HL, Bailliard F, Houyel L, St Louis JD, Lopez L, Aiello VD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski BJ, Stellin G, Weinberg PM, Jacobs ML, Boris JR, Cohen MS, Everett AD, Giroud JM, Guleserian KJ, Hughes ML, Juraszek AL, Seslar SP, Shepard CW, Srivastava S, Cook AC, Crucean A, Hernandez LE, Loomba RS, Rogers LS, Sanders SP, Savla JJ, Tierney ESS, Tretter JT, Wang L, Elliott MJ, Mavroudis C, Tchervenkov CI. Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). World J Pediatr Congenit Heart Surg 2021; 12:E1-E18. [PMID: 34304616 DOI: 10.1177/21501351211032919] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/15/2022]
Abstract
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC. The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
Collapse
Affiliation(s)
- Jeffrey P Jacobs
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America
| | - Rodney C G Franklin
- Paediatric Cardiology Department, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Marie J Béland
- Division of Paediatric Cardiology, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| | - Diane E Spicer
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America.,Johns Hopkins All Children's Hospital, Johns Hopkins University, Saint Petersburg, Florida, United States of America
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, United States of America
| | - Henry L Walters
- Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Frédérique Bailliard
- Bailliard Henry Pediatric Cardiology, Raleigh, North Carolina, United States of America.,Duke University, Durham, North Carolina, United States of America
| | - Lucile Houyel
- Congenital and Pediatric Medico-Surgical Unit, Necker Hospital-M3C, Paris, France
| | - James D St Louis
- Department of Surgery and Pediatrics, Children Hospital of Georgia, Augusta University, Augusta, Georgia
| | - Leo Lopez
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Vera D Aiello
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - J William Gaynor
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Otto N Krogmann
- Pediatric Cardiology-Congenital Heart Disease, Heart Center Duisburg, Duisburg, Germany
| | - Hiromi Kurosawa
- Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Bohdan J Maruszewski
- Department for Pediatric and Congenital Heart Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgical Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Paul Morris Weinberg
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | | | - Jeffrey R Boris
- Jeffrey R. Boris, MD LLC, Moylan, Pennsylvania, United States of America
| | - Meryl S Cohen
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Allen D Everett
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jorge M Giroud
- All Children's Hospital, Saint Petersburg, Florida, United States of America
| | - Kristine J Guleserian
- Congenital Heart Surgery, Medical City Children's Hospital, Dallas, Texas, United States of America
| | - Marina L Hughes
- Cardiology Department, Norfolk and Norwich University Hospital NHS Trust, United Kingdom
| | - Amy L Juraszek
- Terry Heart Institute, Wolfson Children's Hospital, Jacksonville, Florida, United States of America
| | - Stephen P Seslar
- Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States of America
| | - Charles W Shepard
- Children's Heart Clinic of Minneapolis, Minneapolis, Minnesota, United States of America
| | - Shubhika Srivastava
- Division of Cardiology, Department of Cardiovascular Medicine, Nemours Cardiac Center at the Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Adrian Crucean
- Congenital Heart Surgery, Birmingham Women's and Children's Foundation Trust Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Lazaro E Hernandez
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, Florida, United States of America
| | - Rohit S Loomba
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States of America
| | - Lindsay S Rogers
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Stephen P Sanders
- Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jill J Savla
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Elif Seda Selamet Tierney
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Justin T Tretter
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Lianyi Wang
- Heart Centre, First Hospital of Tsinghua University, Beijing, China
| | | | - Constantine Mavroudis
- Johns Hopkins University, Baltimore, Maryland, United States of America.,Peyton Manning Children's Hospital, Indianapolis, Indiana, United States of America
| | - Christo I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| |
Collapse
|
9
|
Marchini GS, Cestari IN, Salemi VMC, Irigoyen MC, Arnold A, Kakoi A, Rocon C, Aiello VD, Cestari IA. Early changes in myocyte contractility and cardiac function in streptozotocin-induced type 1 diabetes in rats. PLoS One 2020; 15:e0237305. [PMID: 32822421 PMCID: PMC7442260 DOI: 10.1371/journal.pone.0237305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/24/2020] [Indexed: 12/29/2022] Open
Abstract
Diabetes can elicit direct deleterious effects on the myocardium, independent of coronary artery disease or hypertension. These cardiac disturbances are termed diabetic cardiomyopathy showing increased risk of heart failure with or without reduced ejection fraction. Presently, there is no specific treatment for this type of cardiomyopathy and in the case of type I diabetes, it may start in early childhood independent of glycemic control. We hypothesized that alterations in isolated myocyte contractility and cardiac function are present in the early stages of experimental diabetes in rats before overt changes in myocardium structure occur. Diabetes was induced by single-dose injection of streptozotocin (STZ) in rats with data collected from control and diabetic animals 3 weeks after injection. Left ventricle myocyte contractility was measured by single-cell length variation under electrical stimulation. Cardiac function and morphology were studied by high-resolution echocardiography with pulsed-wave tissue Doppler imaging (TDI) measurements and three-lead surface electrocardiogram. Triglycerides, cholesterol and liver enzyme levels were measured from plasma samples obtained from both groups. Myocardial collagen content and perivascular fibrosis of atria and ventricle were studied by histological analysis after picrosirius red staining. Diabetes resulted in altered contractility of isolated cardiac myocytes with increased contraction and relaxation time intervals. Echocardiography showed left atrium dilation, increased end-diastolic LV and posterior wall thickness, with reduced longitudinal systolic peak velocity (S’) of the septum mitral annulus at the apical four-chamber view obtained by TDI. Triglycerides, aspartate aminotransferase and alkaline phosphatase were elevated in diabetic animals. Intertitial collagen content was higher in atria of both groups and did not differ among control and diabetic animals. Perivascular intramyocardial arterioles collagen did not differ between groups. These results suggest that alterations in cardiac function are present in the early phase in this model of diabetes type 1 and occur before overt changes in myocardium structure appear as evaluated by intersticial collagen deposition and perivascular fibrosis of intramyocardial arterioles.
Collapse
Affiliation(s)
- Gustavo S. Marchini
- Biomedical Engineering Graduate Progam, University of São Paulo Polytechnic School, São Paulo, Brazil
| | - Ismar N. Cestari
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Vera M. C. Salemi
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | | | - Alexandre Arnold
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Adélia Kakoi
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Camila Rocon
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Vera D. Aiello
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Idágene A. Cestari
- Biomedical Engineering Graduate Progam, University of São Paulo Polytechnic School, São Paulo, Brazil
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
- * E-mail:
| |
Collapse
|
10
|
Chokr MO, Moura LG, Aiello VD, Santos Sousa ÍB, Lopes HB, Carmo AAL, Pisani CF, Hardy CA, Melo SL, Scanavacca MI. Catheter ablation of the parahisian accessory pathways from the aortic cusps—Experience of 20 cases—Improving the mapping strategy for better results. J Cardiovasc Electrophysiol 2020; 31:1413-1419. [PMID: 32298040 DOI: 10.1111/jce.14499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Muhieddine O. Chokr
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Lucas G. Moura
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Vera D. Aiello
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | | | - Hugo B. Lopes
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Andre A. L. Carmo
- Hospital das Clinicas and Faculdade de MedicinaUniversidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Cristiano F. Pisani
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Carina A. Hardy
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Sissy L. Melo
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | | |
Collapse
|
11
|
De Almeida MC, Stephenson RS, Anderson RH, Benvenuti LA, Loukas M, Aiello VD. Human subpulmonary infundibulum has an endocardial network of specialized conducting cardiomyocytes. Heart Rhythm 2020; 17:123-130. [PMID: 31377422 DOI: 10.1016/j.hrthm.2019.07.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 12/13/2022]
|
12
|
Thomaz AM, Kajita LJ, Aiello VD, Zorzanelli L, Galas FRB, Machado CG, Barbero-Marcial M, Jatene MB, Rabinovitch M, Lopes AA. EXPRESS: Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments. Pulm Circ 2019; 9:2045894019837885. [PMID: 30806154 PMCID: PMC6688149 DOI: 10.1177/2045894019837885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/20/2019] [Indexed: 01/22/2023] Open
Abstract
Management of pediatric pulmonary hypertension associated with congenital heart disease (PHT-CHD) is challenging. Some patients have persistently elevated pulmonary artery pressure (PAP) after cardiac surgery, an undesired condition that is difficult to predict. We investigated the value of clinical, hemodynamic, and histopathological data in predicting the outcome in a prospective cohort. Patients with PHT-CHD received sildenafil orally pre- and postoperatively for six months and then were subjected to a catheter study. Thirty-three patients were enrolled (age range = 4.6–37.0 months). Pulmonary vascular resistance (PVR) was 4.9 (range = 3.9–7.2) Wood units × m2 (median with IQR). Twenty-two patients had a ≥ 20% decrease in PVR and pulmonary-to-systemic vascular resistance ratio (PVR/SVR) in response to inhaled nitric oxide (NO). The response was directly related to the degree of medial hypertrophy of pulmonary arterioles (P < 0.05) (morphometric analysis, intraoperative lung biopsy). Subsequently, five of the non-responders had a ≥ 30% increase in pulmonary blood flow in response to sildenafil (3.0 [2.0–4.0] mg/kg/day). Six months after surgery, PAP and PVR were significantly lower (P < 0.001 vs. baseline), even in seven patients with Heath-Edwards grade III/IV pulmonary vascular lesions (P = 0.018), but still abnormal in 12 individuals (>25 mmHg and >3.0 U × m2, respectively). A preoperative PVR/SVR of ≥24% during NO inhalation and a wall thickness of arteries accompanying respiratory bronchioli of ≥4.7 (Z score) were identified, respectively, as risk and protection factors for abnormal postoperative hemodynamics (hazard ratio [95% CI] = 1.09 [1.01–1.18], P = 0.036; and 0.69 [0.49–0.98], P = 0.040, respectively). Thus, in PHT-CHD patients receiving oral sildenafil pre- and post-surgical repair of cardiac lesions, mid-term postoperative outcome is predictable to some extent.
Collapse
Affiliation(s)
- Ana Maria Thomaz
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | - Luiz J. Kajita
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | - Vera D. Aiello
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | - Leína Zorzanelli
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | | | - Cleide G. Machado
- Hospital das Clínicas, University of São
Paulo School of Medicine, São Paulo, Brazil
| | | | - Marcelo B. Jatene
- Heart Institute, University of São Paulo
School of Medicine, São Paulo, Brazil
| | | | | |
Collapse
|
13
|
Carstens GR, Paulino BBA, Katayama EH, Amato-Lourenço LF, Fonseca GH, Souza R, Aiello VD, Mauad T. Clinical relevance of pulmonary vasculature involvement in sickle cell disease. Br J Haematol 2019; 185:317-326. [PMID: 30739309 DOI: 10.1111/bjh.15795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/14/2018] [Indexed: 12/21/2022]
Abstract
Pulmonary complications are frequent in patients with sickle cell disease (SCD), but few studies have described lung pathology in SCD. We studied the lung tissue of 30 deceased SCD patients (1994-2012). Demographics, genotype, clinical characteristics, cause of death and associated conditions are presented. We quantified the presence of pulmonary arterial changes, thrombosis and venous thickening. Alveolar capillary abnormalities were demonstrated using CD34 expression and confocal microscopy. Autopsy and echocardiography reports were reviewed to classify heart abnormalities. Tissue expression of markers of endothelial activation (vascular cell adhesion molecule 1, intercellular adhesion molecule 1 and vascular endothelial growth factor) was quantified in pulmonary vessels. Median age was 33 years; genotype was SS in 19, SC in 7 and Sβ in 4, and there were 18 males. Hypertensive arterial changes were present in 76% of the patients, recent thrombosis in 80% and old thrombosis in 43%. Venous thickening was present in 23% and pulmonary capillary haemangiomatosis foci in 87%. Ten percent of the patients presented right ventricular hypertrophy. There was no increased expression of endothelial activation markers when compared to controls. SCD affects the whole pulmonary vascular tree and reflects the multiple burden on lung vasculature imposed by the disease upon time.
Collapse
Affiliation(s)
- German R Carstens
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Hospital Eduardo Schütz Schroeder, Puerto Montt, Chile
| | - Bianca B A Paulino
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edgard H Katayama
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luis F Amato-Lourenço
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Guilherme H Fonseca
- Department of Haematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rogerio Souza
- Pulmonary Department, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera D Aiello
- Laboratory of Pathology, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Mauad
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
14
|
Magalhães LP, Guimarães I, Melo SL, Mateo E, Andalaft RB, Xavier L, Lorga AM, Fagundes AA, Moreira D, Hachul DT, Sternick EB, Andrea EM, Cannavan F, Oliveira F, Darrieux F, Lima GG, Atié J, Elias J, Zimerman LI, Miana L, Pellanda LC, Sacilotto L, Jatene MB, Soares MM, Binotto MA, Scanavacca MI, Oliveira NA, Zielinsky P, Salerno PR, Teixeira RA, Kuniyoshi RR, Costa R, Schames S, Pedra S, Gimenez SC, Wu TC, Aiello VD. [Not Available]. Arq Bras Cardiol 2016; 107:1-58. [PMID: 27487201 DOI: 10.5935/abc.20160103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
15
|
Caramuru LH, Lopes AA, Maeda NY, Aiello VD, Filho CC. Long-term Behavior of Endothelial and Coagulation Markers in Eisenmenger Syndrome. Clin Appl Thromb Hemost 2016; 12:175-83. [PMID: 16708119 DOI: 10.1177/107602960601200205] [Citation(s) in RCA: 6] [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: 11/15/2022] Open
Abstract
The long-term behavior of endothelial markers was studied in patients with Eisenmenger syndrome who were subjected to conventional therapy (no vasodilators) and observed for 18 months. Biochemical markers were analyzed comparatively in patients with class II or III symptoms (group 1, n=10) and patients with class IV symptoms (group 2, n=7). Plasma von Willebrand factor antigen (vWF: Ag), thrombomodulin, tissue-type plasminogen activator (t-PA) and its inhibitor (PAI-1), and D-dimer were determined by immunoenzymatic assay at baseline, and at 6, 12, and 18 months. At baseline, the main clinical difference between groups was a decreased peripheral oxygen saturation in group 2 versus group 1 (77±5% and 86±4%, respectively, p=0.001). Basal vWF: Ag and t-PA were increased and thrombomodulin was decreased in both groups in comparison with controls (p<0.0001), while D-dimer was increased in group 2 only (p=0.0003). In response to treatment, there was a decrease in vWF: Ag in both groups (19% and 23%, respectively in groups 1 and 2, at 18 months vs. baseline, p<0.0001) and t-PA in group 1 (38% vs. baseline, p=0.0485). Plasma vWF: Ag tended to be higher in group 2 in comparison with group 1 during the whole follow-up. Levels of PAI-1 greater than 38.4 ng/mL (upper 90% limit for normals) and D-dimer greater than 500 ng/mL were detected in individual patients (both groups) during the follow-up period. Thrombomodulin remained decreased in both groups. Thus, severity of symptoms in the Eisenmenger syndrome appears to correlate with low oxygen saturation and higher vWF: Ag levels. Improvement of endothelial dysfunction may occur in response to treatment, although increased risk for thrombosis persists, in view of residual abnormalities.
Collapse
Affiliation(s)
- Lúcia H Caramuru
- The Heart Institute, InCor, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
16
|
Lopes AA, Barst RJ, Haworth SG, Rabinovitch M, Al Dabbagh M, Del Cerro MJ, Ivy D, Kashour T, Kumar K, Harikrishnan S, D'Alto M, Thomaz AM, Zorzanelli L, Aiello VD, Mocumbi AO, Santana MVT, Galal AN, Banjar H, Tamimi O, Heath A, Flores PC, Diaz G, Sandoval J, Kothari S, Moledina S, Gonçalves RC, Barreto AC, Binotto MA, Maia M, Al Habshan F, Adatia I. Repair of congenital heart disease with associated pulmonary hypertension in children: what are the minimal investigative procedures? Consensus statement from the Congenital Heart Disease and Pediatric Task Forces, Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2014; 4:330-41. [PMID: 25006452 DOI: 10.1086/675995] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 11/04/2022] Open
Abstract
Standardization of the diagnostic routine for children with congenital heart disease associated with pulmonary arterial hypertension (PAH-CHD) is crucial, in particular since inappropriate assignment to repair of the cardiac lesions (e.g., surgical repair in patients with elevated pulmonary vascular resistance) may be detrimental and associated with poor outcomes. Thus, members of the Congenital Heart Disease and Pediatric Task Forces of the Pulmonary Vascular Research Institute decided to conduct a survey aimed at collecting expert opinion from different institutions in several countries, covering many aspects of the management of PAH-CHD, from clinical recognition to noninvasive and invasive diagnostic procedures and immediate postoperative support. In privileged communities, the vast majority of children with congenital cardiac shunts are now treated early in life, on the basis of noninvasive diagnostic evaluation, and have an uneventful postoperative course, with no residual PAH. However, a small percentage of patients (older at presentation, with extracardiac syndromes or absence of clinical features of increased pulmonary blood flow, thus suggesting elevated pulmonary vascular resistance) remain at a higher risk of complications and unfavorable outcomes. These patients need a more sophisticated diagnostic approach, including invasive procedures. The authors emphasize that decision making regarding operability is based not only on cardiac catheterization data but also on the complete diagnostic picture, which includes the clinical history, physical examination, and all aspects of noninvasive evaluation.
Collapse
Affiliation(s)
- Antonio Augusto Lopes
- Heart Institute, University of São Paulo, São Paulo, Brazil ; Leader of the Congenital Heart Disease Task Force, PVRI
| | - Robyn J Barst
- Columbia University College of Physicians and Surgeons, New York, New York, USA ; In memoriam
| | | | - Marlene Rabinovitch
- Stanford University School of Medicine, Stanford, California, USA ; Leader of the Congenital Heart Disease Task Force, PVRI
| | | | - Maria Jesus Del Cerro
- La Paz Children's Hospital, Madrid, Spain ; Leader of the Pediatric Task Force, PVRI
| | - Dunbar Ivy
- Children's Hospital Colorado, Aurora, Colorado, USA
| | | | | | - S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | - Vera D Aiello
- Heart Institute, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Hanaa Banjar
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Omar Tamimi
- King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia
| | | | | | - Gabriel Diaz
- Universidad Nacional de Colombia, Bogota, Colombia
| | | | - Shyam Kothari
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | - Margarida Maia
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ian Adatia
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Leader of the Pediatric Task Force, PVRI
| |
Collapse
|
17
|
Aiello VD, Campos PR, Issa V, Honorato R, Fiorelli AI, Bocchi EA. THE TRANSPULMONARY GRADIENT BUT NOT THE SYSTOLIC OR MEAN PULMONARY ARTERIAL PRESSURE CORRELATES WITH THE WALL THICKNESS OF PERIPHERAL PULMONARY ARTERIES AND VEINS IN PATIENTS WITH CHRONIC HEART FAILURE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61492-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
18
|
Pinto NC, Pomerantzeff PMA, Deana A, Zezell D, Marcos RL, Martins RABL, Aiello VD, Jatene FB, Lopes LA, Chavantes MC. High power laser in chordae tendineae to improve heart mitral regurgitation: an experimental study in swine. J Cardiothorac Surg 2013. [PMCID: PMC3845833 DOI: 10.1186/1749-8090-8-s1-o282] [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: 11/10/2022] Open
|
19
|
Walsh MJ, Ungerleider RM, Aiello VD, Spicer D, Giroud JM. Anomalous pulmonary venous connections and related anomalies: nomenclature, embryology, anatomy, and morphology. World J Pediatr Congenit Heart Surg 2013; 4:30-43. [PMID: 23799752 DOI: 10.1177/2150135112458439] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article combines material from three complementary overviews presented in the Symposium on Pulmonary Venous Anomalies during the Joint Meeting of the World Society for Pediatric and Congenital Heart Surgery and Sociedad Latina de Cardiologia y Cirugia Cardiovascular Pediátrica in Lima, Peru. We discuss the embryologic basis for nomenclature, the hierarchical diagnostic categories, and the important anatomic and morphologic characteristics of anomalous pulmonary venous connections. The anatomic descriptions help to guide an understandable and sensible approach to the diagnosis and surgical management of these various disorders.
Collapse
Affiliation(s)
- Michael J Walsh
- Division of Pediatric Cardiology, Brenner Children's Hospital, Wake Forest University Medical Center, Winston Salem, NC 27157, USA.
| | | | | | | | | |
Collapse
|
20
|
Marins L, Anderson RH, Aiello VD. Extrapericardial origin of the entirety of the left pulmonary artery in the absence of a pulmonary arterial sling. Cardiovasc Pathol 2013. [PMID: 23177045 DOI: 10.1016/j.carpath.2012.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
21
|
Miana LA, Assad RS, Abduch MCD, Silva GJJ, Nogueira AR, Aiello VD, Moreira LFP. Reversible Pulmonary Trunk Banding VIII: Intermittent Overload Causes Harmless Hypertrophy in Adult Goat. Ann Thorac Surg 2013; 95:1422-8. [PMID: 23434258 DOI: 10.1016/j.athoracsur.2013.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 10/04/2012] [Revised: 12/28/2012] [Accepted: 01/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Leonardo A Miana
- Laboratory of Cardiovascular Surgery Research, LIM-11, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil.
| | | | | | | | | | | | | |
Collapse
|
22
|
Giroud JM, Jacobs JP, Fricker FJ, Spicer D, Backer C, Franklin RC, Beland MJ, Krogmann ON, Aiello VD, Colan SD, Everett AD, Gaynor JW, Kurosawa H, Maruszewski B, Stellin G, Tchervenkov CI, Walters HL, Weinberg P, Fogel MA, Jacobs ML, Elliott MJ, Anderson RH. Web based “Global Virtual Museum of Congenital Cardiac Pathology”. Progress in Pediatric Cardiology 2012. [DOI: 10.1016/j.ppedcard.2011.12.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
Lemos PA, Takimura CK, Laurindo FRM, Gutierrez PS, Aiello VD. A histopathological comparison of different definitions for quantifying in-stent neointimal tissue: implications for the validity of intracoronary ultrasound and optical coherence tomography measurements. Cardiovasc Diagn Ther 2011; 1:3-10. [PMID: 24282681 DOI: 10.3978/j.issn.2223-3652.2011.10.03] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 10/27/2011] [Indexed: 11/14/2022]
Abstract
PURPOSE Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) define neointima as the tissue encompassed between the stent and the lumen boundaries. This approach differs from the gold-standard histopathology, where neointima is traditionally calculated as the tissue between the internal elastic lamina (IEL) and the lumen. We aimed to investigate whether the neointimal assessment using IVUS and OCT-like definitions would correlate with the traditional histopathological quantification of neointima. METHODS Histopathological analysis was obtained from a porcine model of 28-day coronary in-stent neointimal proliferation (n=13 bare stents). Traditional histopathology neointimal area (NIHPATH area) was calculated as the lumen area minus the IEL area, while the percent neointimal obstruction was defined as NIHPATH area divided by the IEL area. The IVUS/OCT-like neointima area (NIHIVUS/OCT area) was defined as the lumen area minus the stent area, while the percent neointimal obstruction was defined as NIHIVUS/OCT area divided by the stent area. RESULTS The neointimal area as well as the percent obstruction were significantly correlated between histopathology and IVUS/OCT-like definitions (R(2)=0.89 and 0.95 respectively; P<0.01 for both). The average absolute difference between the IVUS/OCT-like and the pathology-like measurements was close to zero, however with a relatively wide dispersion (difference for neointimal area: 0.41 mm(2) [95% CI 1.72 to (-)0.90 mm(2)]; difference for percent neointimal obstruction: 2.5% [95% CI 11.5% to (-)6.5%]). CONCLUSIONS The present findings support the use of stent area in replacement to IEL area, as in IVUS & OCT imaging protocols, for the calculation of neointimal parameters in experimental model of restenosis.
Collapse
Affiliation(s)
- Pedro A Lemos
- The Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
24
|
Castelli JB, Siciliano RF, Vieira RD, Aiello VD, Strabelli TM. Fatal adenoviral necrotizing bronchiolitis case in a post-cardiac surgery intensive care unit. Braz J Infect Dis 2011; 15:285-7. [PMID: 21670932 DOI: 10.1016/s1413-8670(11)70190-8] [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: 11/23/2010] [Accepted: 12/23/2010] [Indexed: 10/27/2022] Open
Abstract
We report a case of a 67 year-old-male patient admitted to the intensive care unit in the post-coronary bypass surgery period who presented cardiogenic shock, acute renal failure and three episodes of sepsis, the latter with pulmonary distress at the 30th post-operative day. The patient expired within five days in spite of treatment with vancomycin, imipenem, colistimethate and amphotericin B. At autopsy severe adenovirus pneumonia was found. Viral pulmonary infections following cardiovascular surgery are uncommon. We highlight the importance of etiological diagnosis to a correct treatment approach.
Collapse
Affiliation(s)
- Jussara Bianchi Castelli
- Laboratory of Pathology, Instituto do Coração, Medical School, Universidade de São Paulo, Brazil.
| | | | | | | | | |
Collapse
|
25
|
Franchi SM, Aiello VD, Lopes AA. Occlusive venopathy phenotype in hereditary pulmonary arterial hypertension. Arq Bras Cardiol 2011; 97:e8-10. [PMID: 21894395 DOI: 10.1590/s0066-782x2011000900019] [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] [Received: 10/23/2009] [Accepted: 03/29/2010] [Indexed: 05/26/2023] Open
Abstract
A 33-year-old male with severe hereditary pulmonary arterial hypertension had a confirmed diagnosis of occlusive venopathy and microvasculopathy. He remained stable for three and a half years on oral sildenafil, 75 mg t.i.d. (six-minute walked distance of 375 m vs 105 m at baseline), but required addition of bosentan (125 mg b.i.d.), subsequently. Despite the fatal outcome at five years post-diagnosis, the observations suggest a potential usefulness of vasodilators as a bridge for lung transplant in selected cases with significant venous/capillary involvement. The occurrence of veno-occlusive and capillary lesions in the familial form of pulmonary arterial hypertension reinforces the difficulties with the current classification of the disease.
Collapse
Affiliation(s)
- Sonia Meiken Franchi
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | |
Collapse
|
26
|
Scanavacca MI, Venancio AC, Pisani CF, Lara S, Hachul D, Darrieux F, Hardy C, Paola E, Aiello VD, Mahapatra S, Sosa E. Percutaneous Transatrial Access to the Pericardial Space for Epicardial Mapping and Ablation. Circ Arrhythm Electrophysiol 2011; 4:331-6. [PMID: 21430128 DOI: 10.1161/circep.110.960799] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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: 11/16/2022]
Affiliation(s)
- Mauricio I Scanavacca
- Arrhythmia Clinical Unit of Heart Institute, University of São Paulo Medical School, Brazil.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Castelli JB, Siciliano RF, Vieira RD, Aiello VD, Strabelli TMV. Fatal adenoviral necrotizing bronchiolitis case in a post-cardiac surgery intensive care unit. Braz J Infect Dis 2011. [DOI: 10.1590/s1413-86702011000300018] [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
|
28
|
Dourado PMM, Tsutsui JM, Landim MBP, Casella Filho A, Galvao TFG, Aiello VD, Mathias W, da Luz PL, Chagas ACP. Rosuvastatin prevents myocardial necrosis in an experimental model of acute myocardial infarction. Braz J Med Biol Res 2011. [PMID: 21445530 DOI: 10.1590/s0100-879x2011007500034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Dyslipidemia is related to the progression of atherosclerosis and is an important risk factor for acute coronary syndromes. Our objective was to determine the effect of rosuvastatin on myocardial necrosis in an experimental model of acute myocardial infarction (AMI). Male Wistar rats (8-10 weeks old, 250-350 g) were subjected to definitive occlusion of the left anterior descending coronary artery to cause AMI. Animals were divided into 6 groups of 8 to 11 rats per group: G1, normocholesterolemic diet; G2, normocholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days after AMI; G3, normocholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days before and after AMI; G4, hypercholesterolemic diet; G5, hypercholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days after AMI; G6, hypercholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days before and after AMI. Left ventricular function was determined by echocardiography and percent infarct area by histology. Fractional shortening of the left ventricle was normal at baseline and decreased significantly after AMI (P < 0.05 in all groups), being lower in G4 and G5 than in the other groups. No significant difference in fractional shortening was observed between G6 and the groups on the normocholesterolemic diet. Percent infarct area was significantly higher in G4 than in G3. No significant differences were observed in infarct area among the other groups. We conclude that a hypercholesterolemic diet resulted in reduced cardiac function after AMI, which was reversed with rosuvastatin when started 30 days before AMI. A normocholesterolemic diet associated with rosuvastatin before and after AMI prevented myocardial necrosis when compared with the hypercholesterolemic condition.
Collapse
Affiliation(s)
- P M M Dourado
- Unidade Clínica de Aterosclerose, Universidade de São Paulo.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Dourado PMM, Tsutsui JM, Landim MBP, Casella Filho A, Galvao TFG, Aiello VD, Mathias W, da Luz PL, Chagas ACP. Rosuvastatin prevents myocardial necrosis in an experimental model of acute myocardial infarction. Braz J Med Biol Res 2011; 44:469-76. [PMID: 21445530 DOI: 10.1590/s0100879x2011007500034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 03/10/2011] [Indexed: 11/21/2022]
Abstract
Dyslipidemia is related to the progression of atherosclerosis and is an important risk factor for acute coronary syndromes. Our objective was to determine the effect of rosuvastatin on myocardial necrosis in an experimental model of acute myocardial infarction (AMI). Male Wistar rats (8-10 weeks old, 250-350 g) were subjected to definitive occlusion of the left anterior descending coronary artery to cause AMI. Animals were divided into 6 groups of 8 to 11 rats per group: G1, normocholesterolemic diet; G2, normocholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days after AMI; G3, normocholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days before and after AMI; G4, hypercholesterolemic diet; G5, hypercholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days after AMI; G6, hypercholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days before and after AMI. Left ventricular function was determined by echocardiography and percent infarct area by histology. Fractional shortening of the left ventricle was normal at baseline and decreased significantly after AMI (P < 0.05 in all groups), being lower in G4 and G5 than in the other groups. No significant difference in fractional shortening was observed between G6 and the groups on the normocholesterolemic diet. Percent infarct area was significantly higher in G4 than in G3. No significant differences were observed in infarct area among the other groups. We conclude that a hypercholesterolemic diet resulted in reduced cardiac function after AMI, which was reversed with rosuvastatin when started 30 days before AMI. A normocholesterolemic diet associated with rosuvastatin before and after AMI prevented myocardial necrosis when compared with the hypercholesterolemic condition.
Collapse
Affiliation(s)
- P M M Dourado
- Unidade Clínica de Aterosclerose, Universidade de São Paulo.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Giroud JM, Jacobs JP, Spicer D, Backer C, Martin GR, Franklin RCG, Béland MJ, Krogmann ON, Aiello VD, Colan SD, Everett AD, William Gaynor J, Kurosawa H, Maruszewski B, Stellin G, Tchervenkov CI, Walters HL, Weinberg P, Anderson RH, Elliott MJ. Report From The International Society for Nomenclature of Paediatric and Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2010; 1:300-13. [PMID: 23804886 DOI: 10.1177/2150135110379622] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tremendous progress has been made in the field of pediatric heart disease over the past 30 years. Although survival after heart surgery in children has improved dramatically, complications still occur, and optimization of outcomes for all patients remains a challenge. To improve outcomes, collaborative efforts are required and ultimately depend on the possibility of using a common language when discussing pediatric and congenital heart disease. Such a universal language has been developed and named the International Pediatric and Congenital Cardiac Code (IPCCC). To make the IPCCC more universally understood, efforts are under way to link the IPCCC to pictures and videos. The Archiving Working Group is an organization composed of leaders within the international pediatric cardiac medical community and part of the International Society for Nomenclature of Paediatric and Congenital Heart Disease ( www.ipccc.net ). Its purpose is to illustrate, with representative images of all types and formats, the pertinent aspects of cardiac diseases that affect neonates, infants, children, and adults with congenital heart disease, using the codes and definitions associated with the IPCCC as the organizational backbone. The Archiving Working Group certifies and links images and videos to the appropriate term and definition in the IPCCC. These images and videos are then displayed in an electronic format on the Internet. The purpose of this publication is to report the recent progress made by the Archiving Working Group in establishing an Internet-based, image encyclopedia that is based on the standards of the IPCCC.
Collapse
Affiliation(s)
- Jorge M. Giroud
- The Congenital Heart Institute of Florida (CHIF), Division of Pediatric Cardiology, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Pediatric Cardiology Associates/Pediatrix Medical Group, Saint Petersburg and Tampa, FL, USA
| | - Jeffrey P. Jacobs
- The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida (CSSofF), Saint Petersburg and Tampa, FL, USA
| | - Diane Spicer
- The Congenital Heart Institute of Florida (CHIF), Division of Pediatric Cardiology, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Pediatric Cardiology Associates/Pediatrix Medical Group, Saint Petersburg and Tampa, FL, USA
- The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida (CSSofF), Saint Petersburg and Tampa, FL, USA
| | - Carl Backer
- Children’s Memorial Hospital, Chicago, IL, USA
| | - Gerard R. Martin
- Center for Heart, Lung and Kidney Disease, Children’s National Medical Center, Washington, DC, USA
| | | | - Marie J. Béland
- Division of Pediatric Cardiology, The Montreal Children’s Hospital of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Otto N. Krogmann
- Paediatric Cardiology–CHD, Heart Center Duisburg, Duisburg, Germany
| | - Vera D. Aiello
- Heart Institute (InCor), Sao Paulo University, School of Medicine, Sao Paulo, Brazil
| | - Steven D. Colan
- Department of Cardiology, Children’s Hospital, Boston, MA, USA
| | - Allen D. Everett
- Pediatric Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - J. William Gaynor
- Cardiac Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hiromi Kurosawa
- Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, Japan
| | - Bohdan Maruszewski
- The Children’s Memorial Health Institute, Department of Cardiothoracic Surgery, Warsaw, Poland
| | - Giovanni Stellin
- Pediatric Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy
| | - Christo I. Tchervenkov
- Division of Pediatric Cardiovascular Surgery, The Montreal Children’s Hospital of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Henry L. Walters
- Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Paul Weinberg
- Division of Pediatric Cardiology, The Children’s Hospital of Philadelphia, PA, USA
| | | | | |
Collapse
|
31
|
Dourado PMM, Landim MBP, Casella Filho A, Tsutsui JM, Galvão TFG, Aiello VD, Mathias W, Luz PL, Chagas ACP. IA 010 A Hypercholesterolemic Diet Cause Augment in the Infarct Size and Worst the Hemodynamics Patterns in Rats Subjects to an Experimental Model of Myocardial Ischemia. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71748-9] [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: 10/20/2022]
|
32
|
Irino ET, Stopiglia AJ, Larsson MH, Fantoni DT, Aiello VD, Kavhegian MA, Simões EA, Santos AL, Gama Filho HA. Avaliação eletrocardiográfica em cães submetidos à pneumonectomia direita. Pesq Vet Bras 2009. [DOI: 10.1590/s0100-736x2009000800001] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O propósito das ressecções pulmonares em cães e gatos, quer sejam por lobectomia ou pneumonectomia, é a cura ou paliação de processos broncopulmonares sempre que os meios conservadores de tratamento clínico sejam considerados ineficientes. Tendo em vista as significativas alterações resultantes da pneumonectomia, novos estudos experimentais devem ser feitos para avaliar as vantagens dessa intervenção cirúrgica e determinar a maneira como aplicá-la com segurança. O presente estudo tem como objetivo avaliar as alterações eletrocardiográficas em dez cães adultos de ambos os sexos, sem raça definida, com 10-30 kg, submetidos à pneumonectomia direita. Foram avaliados diariamente os parâmetros clínicos de cada cão e as alterações em todas as derivações do eletrocardiograma. Todos os cães apresentaram um bom desenlace pós-operatório. Apenas um cão apresentou alteração de relevância clínica, um caso de complexos ventriculares prematuros, possivelmente decorrente da parada cardiorrespiratória, que foi revertido com sucesso. Houve diminuição da amplitude dos complexos QRS nos primeiros 14 dias, retornado ao normal após 60 dias de pós-operatório.
Collapse
|
33
|
Fiorelli AI, Coelho GHB, Oliveira JL, Aiello VD, Benvenuti LA, Santos A, Chi A, Tallans A, Igushi ML, Bacal F, Bocchi EA, Stolf NAG. Endomyocardial biopsy as risk factor in the development of tricuspid insufficiency after heart transplantation. Transplant Proc 2009; 41:935-7. [PMID: 19376392 DOI: 10.1016/j.transproceed.2009.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Endomyocardial biopsy (EMB), which is used to monitor for rejection, may cause tricuspid regurgitation (TR) after orthotopic heart transplantation (OHT). The purpose of this investigation was to examine the occurrence of tricuspid valve tissue in myocardial specimens obtained by routine EMB performed after OHT. PATIENTS AND METHODS From January 2000 to July 2008, 125 of the patients who underwent OHT survived more than 1 month. Their follow-up varied from 1 month to 8.5 years (mean, 5.1 +/- 3.7 years). EMB was the gold standard examination and myocardial scintigraphy with gallium served as a screen to routinely monitor rejection. RESULTS Each of 428 EMB including 4 to 7 fragments, totaling 1715 fragments, were reviewed for this study. The number of EMB per patient varied from 3 to 8 (mean, 4.6 +/- 3.5). Histopathological analysis of these fragments showed tricuspid tissue in 4 patients (3.2%), among whom only 1 showed aggravation of TR. CONCLUSIONS EMB remains the standard method to diagnose rejection after OLT. It can be performed with low risk. Reducing the number of EMB using gallium myocardial scintigraphy or other alternative methods as well as adoption of special care during the biopsy can significantly minimize trauma to the tricuspid valve.
Collapse
Affiliation(s)
- A I Fiorelli
- Heart Institute, São Paulo University School of Medicine, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abduch MCD, Assad RS, Aiello VD. Experimental ventricular pressure overload in young animals induces cardiomyocyte hypertrophy in addition to hyperplasia of contractile and noncontractile elements of the myocardium. J Thorac Cardiovasc Surg 2009; 137:1573. [PMID: 19464493 DOI: 10.1016/j.jtcvs.2009.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 01/30/2009] [Indexed: 11/27/2022]
|
35
|
Affiliation(s)
- Petronio G Thomaz
- Heart Institute (InCor), University of São Paulo Medical School, Avenue Dr. Eneas Carvalho Aguiar 44, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
36
|
Sampaio RO, Fae KC, Demarchi LMF, Pomerantzeff PMA, Aiello VD, Spina GS, Tanaka AC, Oshiro SE, Grinberg M, Kalil J, Guilherme L. Rheumatic heart disease: 15 years of clinical and immunological follow-up. Vasc Health Risk Manag 2008; 3:1007-17. [PMID: 18200819 PMCID: PMC2350126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Rheumatic fever (RF) is a sequel of group A streptococcal throat infection and occurs in untreated susceptible children. Rheumatic heart disease (RHD), the major sequel of RF, occurs in 30%-45% of RF patients. RF is still considered endemic in some regions of Brazil and is responsible for approximately 90% of early childhood valvular surgery in the country. In this study, we present a 15-year clinical follow-up of 25 children who underwent surgical valvular repair. Histopathological and immunological features of heart tissue lesions of RHD patients were also evaluated. The patients presented severe forms of RHD with congestive symptoms at a very young age. Many of them had surgery at the acute phase of RF. Histological analysis showed the presence of dense valvular inflammatory infiltrates and Aschoff nodules in the myocardium of 21% of acute RHD patients. Infiltrating T-cells were mainly CD4+ in heart tissue biopsies of patients with rheumatic activity. In addition, CD4+ and CD8+ infiltrating T-cell clones recognized streptococcal M peptides and cardiac tissue proteins. These findings may open the possibilities of new ways of immunotherapy. In addition, we demonstrated that the surgical procedure during acute phase of the disease improved the quality of life of young RHD patients.
Collapse
|
37
|
Abduch MCD, Assad RS, Rodriguez MQ, Valente AS, Andrade JL, Demarchi LMM, Marcial MB, Aiello VD. Reversible pulmonary trunk banding III: Assessment of myocardial adaptive mechanisms—contribution of cell proliferation. J Thorac Cardiovasc Surg 2007; 133:1510-6. [PMID: 17532949 DOI: 10.1016/j.jtcvs.2006.12.010] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 11/20/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Rapid ventricular conditioning induced by pulmonary artery banding has been recommended for patients with transposition of the great arteries who have lost the chance for the arterial switch operation or whose systemic (right) ventricle failed after the atrial switch. The present study was designed to experimentally evaluate 2 types of pulmonary artery banding (continuous and intermittent) and verify histologically the changes (hypertrophy or hyperplasia or both) of cardiomyocytes and vascular and interstitial cells from the stimulated ventricle beyond the neonatal period. METHODS Twenty-one goats, 30 to 60 days old, were divided into 3 groups, each comprising 7 animals, as follows: control group (no surgical procedure); continuously stimulated group (systolic overload maintained for 96 hours); and intermittently stimulated group (4 periods of 12-hour systolic overload, alternated with a resting period of 12 hours). The animals were then killed for histologic and immunohistochemical analysis of the hearts. Murine monoclonal antibody Ki-67 was used as a proliferation cell marker. Myocardial collagen area fraction was determined by Sirius red staining. RESULTS For both stimulated groups, a significant increase occurred in right ventricular cardiomyocytes and respective nuclei diameters compared with the controls (P < .05). The number of Ki-67-positive cardiomyocytes and interstitial/vessel cells from the right ventricle was augmented in both trained groups in relation to the left ventricle (P < .05). There was no significant difference in the right ventricular collagen area fraction from both trained groups compared with controls. CONCLUSIONS Irrespective of the shorter training time (periods of overload intercalated with resting), the intermittent stimulation regimen was able to produce a similar training of the subpulmonary ventricle compared with the continuous stimulation regarding mass acquisition, cell hypertrophy, and hyperplasia.
Collapse
Affiliation(s)
- Maria C D Abduch
- Laboratory of Pathology, Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Castelli JB, Maeda WT, Aiello VD. Respiratory syncytial virus as a trigger of a pulmonary hypertensive crisis after operative correction of aortic coarctation. Cardiol Young 2007; 17:223-5. [PMID: 17319977 DOI: 10.1017/s1047951107000327] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2006] [Indexed: 11/06/2022]
Abstract
We discuss a 9-month-old male baby, submitted to surgery for correction of aortic coarctation, who showed severe bronchospasm, hypoxaemia, and cardio-respiratory arrest, and who died on the fifth postoperative day. The autopsy revealed histological signs of severe pulmonary vasoconstriction, possibly as a consequence of hypoxaemia secondary to bronchiolitis due to infection with the respiratory syncytial virus. This supposition was confirmed when viruses were detected in pulmonary tissue by immunohistochemistry and electron microscopy.
Collapse
Affiliation(s)
- Jussara B Castelli
- Laboratory of Pathology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
| | | | | |
Collapse
|
39
|
Jacobs JP, Franklin RCG, Wilkinson JL, Cochrane AD, Karl TR, Aiello VD, Béland MJ, Colan SD, Elliott MJ, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski B, Stellin G, Tchervenkov CI, Weinberg PM. The nomenclature, definition and classification of discordant atrioventricular connections. Cardiol Young 2006; 16 Suppl 3:72-84. [PMID: 17378044 DOI: 10.1017/s1047951106000795] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [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: 11/07/2022]
Abstract
During the process of creation of a bidirectional crossmap between the system emerging, on the one hand, from the initiative sponsored by the Congenital Heart Committees of the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons, and on the other hand, from that formulated by the Coding Committee of the European Association for Pediatric Cardiology, the Nomenclature Working Group has successfully created the International Paediatric and Congenital Cardiac Code. As would be expected, during the process of crossmapping it became clear that, for most lesions, the European Pediatric Cardiac Code was more complete in its description of the diagnoses, while the International Congenital Heart Surgery Nomenclature and Database Project was more complete in its description of the procedures. This process of crossmapping exemplifies the efforts of the Nomenclature Working Group to create a comprehensive and all-inclusive international system for the naming of paediatric and congenital cardiac disease, the International Pediatric and Congenital Cardiac Code. Although names and classification for paediatric and congenital cardiac disease will continue to evolve over time, we are now closer than ever to reaching uniform international agreement and standardization. The International Paediatric and Congenital Cardiac Code can be downloaded from the Internet, free of charge, at www.ipccc. net.
Collapse
|
40
|
Tchervenkov CI, Jacobs JP, Weinberg PM, Aiello VD, Béland MJ, Colan SD, Elliott MJ, Franklin RCG, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski B, Stellin G. The nomenclature, definition and classification of hypoplastic left heart syndrome. Cardiol Young 2006; 16:339-68. [PMID: 16839428 DOI: 10.1017/s1047951106000291] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [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] [Accepted: 02/03/2006] [Indexed: 12/18/2022]
Abstract
The hypoplastic left heart syndrome encompasses a spectrum of cardiac malformations that are characterized by significant underdevelopment of the components of the left heart and the aorta, including the left ventricular cavity and mass. At the severe end of the spectrum is found the combination of aortic and mitral atresia, when the left ventricle can be close to non-existent. At the mild end are the patients with hypoplasia of the aortic and mitral valves, but without intrinsic valvar stenosis or atresia, and milder degrees of left ventricular hypoplasia. Although the majority of the patients are suitable only for functionally univentricular repair, a small minority may be candidates for biventricular repair. The nature of the syndrome was a topic for discussion at the second meeting of the International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease, the Nomenclature Working Group, held in Montreal, Canada, over the period January 17 through 19, 2003. Subsequent to these discussions, the Nomenclature Working Group was able to create a bidirectional crossmap between the nomenclature initially produced jointly on behalf of the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons, and the alternative nomenclature developed on behalf of the Association for European Paediatric Cardiology. This process is a part of the overall efforts of the Nomenclature Working Group to create a comprehensive and all-inclusive international system of nomenclature for paediatric and congenital cardiac disease, the International Paediatric and Congenital Cardiac Code. In this review, we discuss the evolution of nomenclature and surgical treatment for the spectrum of lesions making up the hypoplastic left heart syndrome and its related malformations. We also present the crossmap of the associated terms for diagnoses and procedures, as recently completed by the Nomenclature Working Group.
Collapse
Affiliation(s)
- Christo I Tchervenkov
- Division of Pediatric Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Quebec, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Dourado PMM, Tsutsui JM, Santos JMT, Aiello VD, Mathias W, Ramires JAF, da Luz PL, Chagas ACP. Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model. Braz J Med Biol Res 2006; 39:825-32. [PMID: 16751990 DOI: 10.1590/s0100-879x2006000600017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Myocardial contrast echocardiography has been used for assessing myocardial perfusion. Some concerns regarding its safety still remain, mainly regarding the induction of microvascular alterations. We sought to determine the bioeffects of microbubbles and real-time myocardial contrast echocardiography (RTMCE) in a closed-chest canine model. Eighteen mongrel dogs were randomly assigned to two groups. Nine were submitted to continuous intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) plus continuous imaging using power pulse inversion RTMCE for 180 min, associated with manually deflagrated high-mechanical index impulses. The control group consisted of 3 dogs submitted to continuous imaging using RTMCE without PESDA, 3 dogs received PESDA alone, and 3 dogs were sham-operated. Hemodynamics and cardiac rhythm were monitored continuously. Histological analysis was performed on cardiac and pulmonary tissues. No hemodynamic changes or cardiac arrhythmias were observed in any group. Normal left ventricular ejection fraction and myocardial perfusion were maintained throughout the protocol. Frequency of mild and focal microhemorrhage areas in myocardial and pulmonary tissue was similar in PESDA plus RTMCE and control groups. The percentages of positive microscopical fields in the myocardium were 0.4 and 0.7% (P = NS) in the PESDA plus RTMCE and control groups, respectively, and in the lungs they were 2.1 and 1.1%, respectively (P = NS). In this canine model, myocardial perfusion imaging obtained with PESDA and RTMCE was safe, with no alteration in cardiac rhythm or left ventricular function. Mild and focal myocardial and pulmonary microhemorrhages were observed in both groups, and may be attributed to surgical tissue manipulation.
Collapse
Affiliation(s)
- P M M Dourado
- Laboratório de Investigação em Isquemia Miocárdica, Unidade Clínica de Aterosclerose, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Jacobs JP, Franklin RCG, Jacobs ML, Colan SD, Tchervenkov CI, Maruszewski B, Gaynor JW, Spray TL, Stellin G, Aiello VD, Béland MJ, Krogmann ON, Kurosawa H, Weinberg PM, Elliott MJ, Mavroudis C, Anderson RH. Classification of the functionally univentricular heart: unity from mapped codes. Cardiol Young 2006; 16 Suppl 1:9-21. [PMID: 16401358 DOI: 10.1017/s1047951105002271] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [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: 11/07/2022]
Abstract
The nomenclature and classification of patients with a functionally univentricular heart has been debated for decades. We review here the approach taken for dealing with this group of patients by the International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Cardiac Disease. We discuss the approach of this Nomenclature Working Group in the context of other historical and contemporary ideas about this topic.
Collapse
Affiliation(s)
- Jeffrey P Jacobs
- The Congenital Heart Institute of Florida, All Children's Hospital, Children's Hospital of Tampa, University of South Florida, Cardiac Surgical Associates, Saint Petersburg, Florida 33701, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Jacobs JP, Maruszewski B, Tchervenkov CI, Lacour-Gayet FG, Jacobs ML, Clarke DR, Gaynor JW, Spray TL, Stellin G, Elliott MJ, Ebels T, Franklin RCG, Béland MJ, Kurosawa H, Aiello VD, Colan SD, Krogmann ON, Weinberg P, Tobota Z, Dokholyan RS, Peterson ED, Mavroudis C. The current status and future directions of efforts to create a global database for the outcomes of therapy for congenital heart disease. Cardiol Young 2005; 15 Suppl 1:190-7. [PMID: 15934716 DOI: 10.1017/s1047951105001289] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [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: 11/07/2022]
Abstract
There are many reasons for seeking to create a global database with which to record the outcomes of therapy for congenital heart disease. Such a database can function as a tool to support a variety of purposes:
Collapse
Affiliation(s)
- Jeffrey P Jacobs
- The Congenital Heart Institute of Florida, Petersburg, FL 33701, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Soares AM, Aiello VD, Andrade JL, Kajita LJ, Soares J, Morhy SS, Mathias W, Lopes AAB, Ramires JAF. Doppler flow evaluation can anticipate abnormal left lung perfusion after transcatheter closure of patent ductus arteriosus. Eur Heart J 2004; 25:1927-33. [PMID: 15522472 DOI: 10.1016/j.ehj.2004.07.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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] [Received: 02/25/2004] [Revised: 06/22/2004] [Accepted: 07/08/2004] [Indexed: 11/20/2022] Open
Abstract
AIMS Coil protrusion into the left pulmonary artery (LPA) has been described after transcatheter closure of the patent ductus arteriosus (PDA). The possible impact of such a finding in lung perfusion has not been completely clarified. We evaluated Doppler flow velocities and lung perfusion in patients submitted to that procedure. METHODS After transcatheter closure of PDA with coils, 70 patients (mean age 8.6+/-3.4 years) were followed for a period of 3.6+/-0.9 years (range 2.1-5.9) and compared to 22 controls. Peak flow velocities and coil protrusion were assessed by Doppler echocardiography. A Doppler velocity index (DVI) was calculated by the difference between the LPA and right pulmonary artery (RPA) peak flow velocities relative to the pulmonary trunk (PT) expressed in percentage, as follows: DVI=(LPA velocity - RPA velocity)/PT velocity x 100. Lung scintigraphy was performed using (99m)Tc-labelled macro-aggregated albumin. RESULTS Device protrusion was observed in 94% of the patients, 10% of whom presented abnormal left lung perfusion. Peak LPA velocity and DVI were significantly greater in patients (p=0.001) and correlated negatively with left lung perfusion values (R(2)=0.21 and R(2)=0.65, respectively). A cut-off value of 50% for the DVI showed high sensitivity and specificity for reduced lung perfusion. CONCLUSION Impaired left lung perfusion may appear following transcatheter closure of PDA with coils and the determination of DVI may anticipate such alteration.
Collapse
Affiliation(s)
- Andressa M Soares
- Laboratory of Echocardiography, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Egito EST, Aiello VD, Bosisio IBJ, Lichtenfels AJ, Horta ALM, Saldiva PHN, Capelozzi VL. Vascular remodeling process in reversibility of pulmonary arterial hypertension secondary to congenital heart disease. Pathol Res Pract 2004; 199:521-32. [PMID: 14533936 DOI: 10.1078/0344-0338-00457] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 11/18/2022]
Abstract
Pulmonary vascular remodeling process was analyzed using morphometry in lung biopsy specimens taken from 26 children, aged 6 to 160 months, who had congenital heart disease and significant pulmonary arterial hypertension. Reparative surgery was performed in 22 patients and palliative surgery was performed in four patients. One patient expired postoperatively and four others after hospital discharge. Vascular remodeling examination revealed a characteristic pathological picture: pronounced medial thickening with increased collagen content (fibrosis), without significant arterial intimal proliferation. At a mean follow-up of 44 months, 72% of the survivors were asymptomatic with no medication. Diagnosed by echocardiogram, 22% of these patients were shown to have pulmonary arterial hypertension. The characteristic pathological features described above occurred in 38% of the patients who either expired or had pulmonary hypertension postoperatively. These findings were an aid to identifying a high risk group in which the outcome does not meet expectations for the classical grade I and II changes. We concluded that the presence of isolated medial thickening does not ensure either survival or a normal postoperative pulmonary arterial pressure at late follow-up and that the collagen content can be a better reference for good outcome. Early intracardiac repair is recommended before the development of significant medial fibrosis.
Collapse
MESH Headings
- Adolescent
- Cardiac Surgical Procedures/mortality
- Child
- Child, Preschool
- Collagen/metabolism
- Extracellular Matrix/metabolism
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/surgery
- Infant
- Male
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Pulmonary Artery/metabolism
- Pulmonary Artery/pathology
- Pulmonary Artery/physiopathology
- Recovery of Function
- Retrospective Studies
- Tunica Media/metabolism
- Tunica Media/pathology
Collapse
Affiliation(s)
- Eryberto S T Egito
- Department of Pathology, São Paulo University School of Medicine, SP, Brazil
| | | | | | | | | | | | | |
Collapse
|
46
|
Béland MJ, Franklin RCG, Jacobs JP, Tchervenkov CI, Aiello VD, Colan SD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski B, Stellin G, Weinberg PM. Update from the International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease. Cardiol Young 2004; 14:225-9. [PMID: 15691420 DOI: 10.1017/s1047951104002239] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [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: 11/06/2022]
Affiliation(s)
- Marie J Béland
- Division of Paediatric Cardiology, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abduch MCD, Tonini PLJ, de Oliveira Domingos Barbusci L, de Oliveira SM, de Freitas RR, Aiello VD. Double-outlet right ventricle associated with discordant atrioventricular connection and dextrocardia in a cat. J Small Anim Pract 2003; 44:374-7. [PMID: 12934814 DOI: 10.1111/j.1748-5827.2003.tb00172.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/26/2022]
Abstract
The prevalence of congenital cardiac disease in cats varies from 0.2 to 1 per cent, with males being more affected than females. This is probably an underestimate due to the fact that not all affected kittens are presented. Discordant atrioventricular connection (where the morphological right atrium connects to the morphological left ventricle, and the morphological left atrium connects to the morphological right ventricle) is an uncommon condition in humans and, to the authors' knowledge, has not to date been described in animals. The association between this anomaly and the double-outlet right ventricle (where both great arteries arise entirely or partially from the morphological right ventricle) is extremely rare in children. This report describes a case of a cat which presented with this association of cardiac defects.
Collapse
Affiliation(s)
- M C D Abduch
- Nucleo Veterinary Diagnosis, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
Humoral response emerges as an important component in acute graft rejection and a new challenge to clinicians in posttransplant care. Management of recurrent episodes and persistent activation of the humoral component of the immune system, despite the usual therapeutic approach to rejection, remains unknown. This article describes the successful use of methotrexate as an option for rescuing a graft in this worrisome situation.
Collapse
Affiliation(s)
- Fernando Bacal
- Heart Failure Department, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
| | | | | | | | | | | | | |
Collapse
|
49
|
Benvenuti LA, Aiello VD, Palomino SAP, Higuchi MDL. Ventricular expression of atrial natriuretic peptide in chronic chagasic cardiomyopathy is not induced by myocarditis. Int J Cardiol 2003; 88:57-61. [PMID: 12659985 DOI: 10.1016/s0167-5273(02)00363-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 10/27/2022]
Abstract
BACKGROUND The ventricles of the normal heart are virtually devoid of atrial natriuretic peptide (ANP). Although ANP occurs in ventricles submitted to elevated wall stress, it is not clear whether ANP expression is affected by myocarditis. We investigated the immunohistochemical expression of ANP in chronic chagasic cardiomyopathy, an inflammatory cardiomyopathy caused by infection with the protozoan Trypanosoma cruzi. METHODS Necropsy samples from the left and right ventricles of 16 patients exhibiting chronic chagasic cardiomyopathy were evaluated for myocarditis, fibrosis, T. cruzi parasites and ANP immunoreactivity. The diameters of 50 myocytes per sample were measured. RESULTS ANP was present in myocytes of the subendocardial region in 13/16 (81.3%) left and 10/16 (62.5%) right ventricular samples (P=0.25). Myocytes present in the inflammatory foci, near the infiltrating inflammatory cells but distant from the subendocardial region, did not express ANP. Trypanosoma cruzi parasites exhibited intense immunoreactivity for ANP. The mean myocyte diameter and the incidence of myocarditis, fibrosis, and T. cruzi parasites was similar between the left and right ventricular samples. No statistical differences were found between the ANP-positive and ANP-negative cases. CONCLUSIONS In chronic chagasic cardiomyopathy, both ventricles exhibit hypertrophy, fibrosis and ANP in the subendocardial region. The inflammatory infiltrate does not induce ANP expression in the myocytes. Regional stress but not myocarditis itself, is probably responsible for ventricular ANP expression in myocarditis.
Collapse
Affiliation(s)
- Luiz A Benvenuti
- Laboratory of Pathology, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar 44, 05403-000, Sao Paulo, Brazil.
| | | | | | | |
Collapse
|
50
|
Dias CA, Assad RS, Caneo LF, Abduch MCD, Aiello VD, Dias AR, Marcial MB, Oliveira SA. Reversible pulmonary trunk banding. II. An experimental model for rapid pulmonary ventricular hypertrophy. J Thorac Cardiovasc Surg 2002; 124:999-1006. [PMID: 12407385 DOI: 10.1067/mtc.2002.124234] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [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: 11/22/2022]
Abstract
OBJECTIVE An experimental model with a reversible pulmonary trunk banding device was developed with the aim of inducing rapid ventricular hypertrophy. The device consists of an insufflatable cuff connected to a self-sealing button. METHODS The right ventricles of 7 young goats (average weight, 8.7 kg) were submitted to systolic overload and evaluated according to the hemodynamic, echocardiographic, and morphologic aspects. Baseline biopsy specimens were taken from the myocardium for microscopic analysis. The device was implanted on the pulmonary trunk and inflated so that a 0.7 right ventricular/left ventricular pressure ratio was achieved. Echocardiographic and hemodynamic evaluations were performed every 24 hours. Systolic overload was maintained for 96 hours. The animals were then killed for morphologic study. Another 9 goats (average weight, 7.7 kg) were used for control right ventricular weight. RESULTS The systolic right ventricular/pulmonary trunk pressure gradient varied from 10.1 +/- 4.3 mm Hg (baseline) to 60.0 +/- 11.0 mm Hg (final). Consequently, the right ventricular/left ventricular pressure ratio increased from 0.29 +/- 0.06 to 1.04 +/- 0.14. The protocol group showed a 74% increase in right ventricular mass when compared with the control group. Serial 2-dimensional echocardiography showed a 66% increase in right ventricular wall thickness. There was a 24% increase in the mean myocyte perimeter, and the myocyte area increased 61%. CONCLUSIONS The device is easily adjustable percutaneously, enabling right ventricular hypertrophy in 96 hours of gradual systolic overload. This study suggests that the adjustable pulmonary trunk banding might provide better results for the 2-stage Jatene operation and for the failed atrial switch operations to convert to the double-switch operation.
Collapse
Affiliation(s)
- Carlos A Dias
- Heart Institute University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | | | | | | | |
Collapse
|