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Luzuriaga GDCJ, Dias RR, Santiago JAD, Madrini V, Ishikawa WY, Fernandes F, Aiello VD. Rare association between giant-cell aortitis and giant-cell aortic valvulitis. Autops Case Rep 2023; 13:e2023449. [PMID: 38034520 PMCID: PMC10688263 DOI: 10.4322/acr.2023.449] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/24/2023] [Indexed: 12/02/2023]
Abstract
Giant cell arteritis (GCA) is a type of chronic vasculitis that affects medium and large-caliber arteries, frequently related to aortic involvement and, consequently, to aneurysm formation. However, associated valvulitis with giant cells is uncommon. We describe the case of a 50-year-old female patient with aortic aneurysm and valvular insufficiency, whose anatomopathological examination revealed giant-cell aortic valvulitis associated with giant cell aortitis.
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Affiliation(s)
- Georgina del Cisne Jadán Luzuriaga
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Miocardiopatias e Doenças da Aorta, São Paulo, SP, Brasil
| | - Ricardo Ribeiro Dias
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Cirurgia Cardiovascular, São Paulo, SP, Brasil
| | - José Augusto Duncan Santiago
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Cirurgia Cardiovascular, São Paulo, SP, Brasil
| | - Vagner Madrini
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Miocardiopatias e Doenças da Aorta, São Paulo, SP, Brasil
| | - Walther Yoshiharu Ishikawa
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Imagem Cardiovascular, São Paulo, SP, Brasil
| | - Fabio Fernandes
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Miocardiopatias e Doenças da Aorta, São Paulo, SP, Brasil
| | - Vera Demarchi Aiello
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Anatomia Patológica, São Paulo, SP, Brasil
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Andrade AR, Correia VM, Santiago JAD, Dias RR, Júnior VM. Aortopulmonary fistula mimicking ductus arteriosus aneurysm on imaging exams. Eur Heart J Case Rep 2023; 7:ytad464. [PMID: 37767232 PMCID: PMC10519873 DOI: 10.1093/ehjcr/ytad464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Alan Rodrigues Andrade
- Department of Cardiomyopathies and Aortic Diseases, Heart Institute (InCor) University of São Paulo, Dr Eneas de Carvalho Aguiar Avenue, number 44, São Paulo, 05403-900 São Paulo, Brazil
| | - Vinícius Machado Correia
- Department of Cardiomyopathies and Aortic Diseases, Heart Institute (InCor) University of São Paulo, Dr Eneas de Carvalho Aguiar Avenue, number 44, São Paulo, 05403-900 São Paulo, Brazil
| | - José Augusto Duncan Santiago
- Department of Cardiomyopathies and Aortic Diseases, Heart Institute (InCor) University of São Paulo, Dr Eneas de Carvalho Aguiar Avenue, number 44, São Paulo, 05403-900 São Paulo, Brazil
| | - Ricardo Ribeiro Dias
- Department of Cardiomyopathies and Aortic Diseases, Heart Institute (InCor) University of São Paulo, Dr Eneas de Carvalho Aguiar Avenue, number 44, São Paulo, 05403-900 São Paulo, Brazil
| | - Vagner Madrini Júnior
- Department of Cardiomyopathies and Aortic Diseases, Heart Institute (InCor) University of São Paulo, Dr Eneas de Carvalho Aguiar Avenue, number 44, São Paulo, 05403-900 São Paulo, Brazil
- Department of Cardiology, Israelita Albert Einstein Hospital, Albert Einstein Avenue, number 627, São Paulo, 05652-900 São Paulo, Brazil
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Rômullo Medeiros S, Ribeiro Dias R, Leyton Pozzo V, Duncan Santiago J, Madrini Junior V, Biscegli Jatene F. Surgical correction of the ascending aorta and an aortic root aneurysm associated with coarctation of the descending aorta. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36314438 DOI: 10.1510/mmcts.2022.052] [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] [Indexed: 06/16/2023]
Abstract
This case report shows how to perform simultaneously an open surgical correction of an aortic root aneurysm and aortic stenosis by interposition of an aortic composite graft and the transdiaphragmatic extra-anatomical correction of an aortic coarctation.
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Affiliation(s)
| | - Ricardo Ribeiro Dias
- Cardiovascular surgery, Heart institute from the University of Sao Paulo, Brazil
| | - Vanina Leyton Pozzo
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Jose Duncan Santiago
- Cardiovascular surgery, Heart institute from the University of Sao Paulo, Brazil
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Guido MC, Lopes NDM, Albuquerque CI, Tavares ER, Jensen L, Carvalho PDO, Tavoni TM, Dias RR, Pereira LDV, Laurindo FRM, Maranhão RC. Treatment With Methotrexate Associated With Lipid Core Nanoparticles Prevents Aortic Dilation in a Murine Model of Marfan Syndrome. Front Cardiovasc Med 2022; 9:893774. [PMID: 35757348 PMCID: PMC9226570 DOI: 10.3389/fcvm.2022.893774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
In Marfan syndrome (MFS), dilation, dissection, and rupture of the aorta occur. Inflammation can be involved in the pathogenicity of aortic defects and can thus be a therapeutic target for MFS. Previously, we showed that the formulation of methotrexate (MTX) associated with lipid nanoparticles (LDE) has potent anti-inflammatory effects without toxicity. To investigate whether LDEMTX treatment can prevent the development of aortic lesions in the MFS murine model. MgΔloxPneo MFS (n = 40) and wild-type (WT, n = 60) mice were allocated to 6 groups weekly injected with IP solutions of: (1) only LDE; (2) commercial MTX; (3) LDEMTX (dose = 1mg/kg) between 3rd and 6th months of life. After 12 weeks of treatments, animals were examined by echocardiography and euthanatized for morphometric and molecular studies. MFS mice treated with LDEMTX showed narrower lumens in the aortic arch, as well as in the ascending and descending aorta. LDEMTX reduced fibrosis and the number of dissections in MFS but not the number of elastic fiber disruptions. In MFS mice, LDEMTX treatment lowered protein expression of pro-inflammatory factors macrophages (CD68), T-lymphocytes (CD3), tumor necrosis factor-α (TNF-α), apoptotic factor cleaved-caspase 3, and type 1 collagen and lowered the protein expression of the transforming growth factor-β (TGF-β), extracellular signal-regulated kinases ½ (ERK1/2), and SMAD3. Protein expression of CD68 and CD3 had a positive correlation with an area of aortic lumen (r2 = 0.36; p < 0.001), suggesting the importance of inflammation in the causative mechanisms of aortic dilation. Enhanced adenosine availability by LDEMTX was suggested by higher aortic expression of an anti-adenosine A2a receptor (A2a) and lower adenosine deaminase expression. Commercial MTX had negligible effects. LDEMTX prevented the development of MFS-associated aortic defects and can thus be a candidate for testing in clinical studies.
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Affiliation(s)
- Maria Carolina Guido
- Laboratory of Metabolism and Lipids, Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Natalia de Menezes Lopes
- Laboratory of Metabolism and Lipids, Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Camila Inagaki Albuquerque
- Laboratory of Metabolism and Lipids, Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Elaine Rufo Tavares
- Laboratory of Metabolism and Lipids, Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Leonardo Jensen
- Laboratory of Hypertension, Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Priscila de Oliveira Carvalho
- Laboratory of Metabolism and Lipids, Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Thauany Martins Tavoni
- Laboratory of Metabolism and Lipids, Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Ricardo Ribeiro Dias
- Department of Cardiovascular Surgery, Heart Institute (InCor), Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Lygia da Veiga Pereira
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | | | - Raul Cavalcante Maranhão
- Laboratory of Metabolism and Lipids, Heart Institute (InCor) of the Medical School Hospital, University of São Paulo, São Paulo, Brazil
- *Correspondence: Raul Cavalcante Maranhão
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Cardoso LF, Dias RR, Demarchi LMMF, Silveira LMVD, Mady C, Jatene FB. Nonatherosclerotic Giant Right Coronary Artery Aneurysm. Braz J Cardiovasc Surg 2022; 37:271-272. [PMID: 35503700 PMCID: PMC9054151 DOI: 10.21470/1678-9741-2020-0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present an unusual case of a 67-year-old woman with an incidental finding of a cardiac mass on a chest computed tomography. Coronary angiotomography confirmed the diagnosis of right coronary artery aneurysm, with 5.7×5.7 cm. The patient underwent aneurysm resection and coronary bypass surgery, with subsequent histologic study suggestive of arteritis sequelae. Giant coronary artery aneurysms have a high risk of complications and aneurysm exclusion must be beneficial. This is a rare condition that can also be part of a systemic inflammatory disease.
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Affiliation(s)
- Lucas Figueredo Cardoso
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ricardo Ribeiro Dias
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lea Maria Macruz Ferreira Demarchi
- Laboratory of Anatomic Pathology, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lucas Molinari Veloso da Silveira
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Charles Mady
- Department of Cardiology, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Lisboa LA, Mejia OAV, Arita ET, Guerreiro GP, Silveira LMVD, Brandão CMDA, Dias RR, Dallan LRP, Miana L, Caneo LF, Jatene MB, Dallan LAO, Jatene FB. Impacto da Primeira Onda da Pandemia de COVID-19 na Cirurgia Cardiovascular no Brasil: Análise de um Centro Terciário de Referência. Arq Bras Cardiol 2022; 118:663-666. [PMID: 35319617 PMCID: PMC8959023 DOI: 10.36660/abc.20210235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/08/2021] [Indexed: 01/13/2023] Open
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Queiroz CMD, Cardoso J, Ramires F, Ianni B, Hotta VT, Mady C, Buck PDC, Dias RR, Nastari L, Fernandes F. Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era. International Journal of Cardiovascular Sciences 2021. [DOI: 10.36660/ijcs.20200247] [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: 11/18/2022] Open
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Sobral MLP, Dias RR, Correia CDJ, Coutinho E Silva RDS, da Anunciação LF, Breithaupt-Faloppa AC, Moreira LFP. Protective effects of 17β-oestradiol on coagulation and systemic inflammation after total occlusion of the descending aorta in male rats. Eur J Cardiothorac Surg 2021; 61:666-674. [PMID: 34528682 DOI: 10.1093/ejcts/ezab381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/23/2021] [Revised: 06/14/2021] [Accepted: 07/04/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The surgical treatment for diseases of the descending aorta is related to a high mortality rate because of the activation of a systemic inflammatory process due to ischaemia and reperfusion (I/R) injury. Activation of coagulation can contribute to the inflammatory process, resulting in microcirculatory damage and multiple organ failure. Our goal was to evaluate the role of prophylactic intravenous 17β-oestradiol (E2) in coagulation, the inflammatory response and hepatic injury after occlusion of the descendent proximal aorta in male rats. METHODS Wistar male rats were randomized and allocated to 3 groups (n = 8 per group): sham, surgically manipulated; IR, animals subjected to I/R; and E2, animals treated with E2 (280 µg/kg, intravenously) before I/R. I/R was induced by insertion of a 2-Fr Fogarty arterial embolectomy catheter in the descending aorta, which was occluded for 20 min, followed by a reperfusion period of 2 h. Serological markers, platelet aggregation, hepatic vascular flow, systemic and liver inflammatory response and apoptosis were analysed. The coagulation process was evaluated by thromboelastometry. RESULTS The aortic occlusion led to a reduction in plasma fibrinogen concentration in parallel with increased clotting time, greater clot firmness and reduced lysis. E2 treatment was able to increase fibrinogen, prevent the increase in clotting time and normalize clot firmness, but it exerted only a mild effect on clot lysis. Platelet aggregation was increased by IR, and E2 treatment was able to reduce it. There was a reduction in flow percentage in the IR group that was not prevented by E2. In parallel, higher aggregate formation was observed in the vessels of the IR group of animals. There was increased systemic release of interleukin-1-β, interleukin-6 and interleukin-10 in the IR group, which was reduced in the treated animals. CONCLUSIONS The current results suggest that pretreatment with E2 before an ischaemic period induced by occlusion of the proximal descending aorta is effective in preventing alterations in coagulation and systemic inflammation due to I/R injury.
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Affiliation(s)
- Marcelo Luiz Peixoto Sobral
- Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM-11), Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Ribeiro Dias
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cristiano de Jesus Correia
- Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM-11), Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Raphael Dos Santos Coutinho E Silva
- Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM-11), Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucas Ferreira da Anunciação
- Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM-11), Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Cristina Breithaupt-Faloppa
- Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM-11), Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Felipe Pinho Moreira
- Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM-11), Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Dallan LRP, Dallan LAO, Duncan Santiago JA, Ribeiro Dias R, Manuel de Almeida Brandao C, Jatene FB. Bentall-de Bono procedure for acute aortic dissection. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 33691047 DOI: 10.1510/mmcts.2021.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a patient with an acute type A aortic dissection that involves the aortic root. The high mortality of patients with this condition is often associated with operations performed by surgeons with minimal experience dealing with aortic diseases. Therefore, less-experienced surgeons often opt for less complicated techniques like supracoronary ascending aortic replacement. However, according to the latest guidelines for the management of aortic diseases, the aortic root should be replaced when it is compromised by the dissection. The Bentall-de Bono technique treats the aortic root and demands less experience than valve-sparing aortic surgery.
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Affiliation(s)
| | | | | | - Ricardo Ribeiro Dias
- Cardiovascular surgery, Heart institute from the University of Sao Paulo, Brazil
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Dinato FJ, Dias RR, Duncan JA, Fernandes F, Ramirez FJA, Mady C, Jatene FB. Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? Braz J Cardiovasc Surg 2020; 35:869-877. [PMID: 33113317 PMCID: PMC7731868 DOI: 10.21470/1678-9741-2020-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. Methods Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression. Results The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35). Conclusion Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction.
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Affiliation(s)
- Fabrício José Dinato
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Augusto Duncan
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fábio Fernandes
- Clinical Unit of Myocardiopathies and Aortic Diseases, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Felix José Alvares Ramirez
- Clinical Unit of Myocardiopathies and Aortic Diseases, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Charles Mady
- Clinical Unit of Myocardiopathies and Aortic Diseases, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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11
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Fernandes F, Melo DTPD, Ramires FJA, Sabino EC, Moreira CHV, Benvenutti LA, Hotta VT, Sayegh ALC, Souza FRD, Dias RR, Mady C. Galectin-3 Levels in Patients with Chronic Constrictive Pericarditis. Arq Bras Cardiol 2020; 114:683-689. [PMID: 32491013 DOI: 10.36660/abc.20190152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background Galectin-3 (Gal-3) is a proinflammatory, profibrotic molecule implicated in the pathogenesis of heart failure. The role of Gal-3 in patients with chronic constrictive pericarditis (CCP) is not clear. Objective The aim of this study was to assess plasma Gal-3 in patients with CCP and correlate it with clinical, functional and histologic parameters. Methods We prospectively evaluated 25 symptomatic patients with CCP referred for pericardiectomy and 21 healthy controls. Patients underwent clinical assessment, Gal-3 and B-type natriuretic peptide (BNP) measurements, echocardiography, cardiac magnetic resonance imaging and cardiopulmonary exercise test (CPET) at baseline. Six months after pericardiectomy CPET was repeated. An alpha error < 5% was considered statistically significant, with a confidence interval of 95%. Results Twenty-five patients with a median age of 45 years were included. Etiology was mainly idiopathic (n = 19, 76%); and 14 (56%) patients had NYHA functional class III/IV. Median BNP and Gal-3 were 143 (89-209) pg/dL and 14.8 (9.7-17.2) ng/mL, respectively. Gal-3 levels were not significantly higher in CCP patients than in control (p = 0.22). There were no significant correlations of Gal-3 with BNP, echocardiographic and cardiac magnetic resonance measures and histological findings. After pericardiectomy, it was found a statistically significant correlation between Gal-3 and the CPTE measures test duration (r = -0.79; p < 0.001) and exercise time (r = -0.79; p < 0.001). Conclusions Patients with CCP had normal levels of Gal-3 as compared to the controls. Gal-3 did not correlate with morphological and functional measures before pericardiectomy. However, the associations between Gal-3 and exercise intolerance after pericardiectomy may suggest a role of Gal-3 in prognosis prediction after pericardiectomy. (Arq Bras Cardiol. 2020; 114(4):683-689).
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Affiliation(s)
- Fábio Fernandes
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Felix José Alvarez Ramires
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | - Luiz Alberto Benvenutti
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Viviane Tiemi Hotta
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ana Luiza Carrari Sayegh
- Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Francis Ribeiro de Souza
- Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Ribeiro Dias
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Charles Mady
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
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12
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Mejia OAV, Lisboa LAF, Caneo LF, Arita ET, Brandão CMDA, Dias RR, Costa R, Jatene MB, Pomerantzeff PMA, Dallan LAO, Jatene FB. Analysis of >100,000 Cardiovascular Surgeries Performed at the Heart Institute and a New Era of Outcomes. Arq Bras Cardiol 2020; 114:603-612. [PMID: 32074203 DOI: 10.36660/abc.20190736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. OBJECTIVE To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School (InCor-HCFMUSP). METHODS An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. RESULTS A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). CONCLUSION In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.
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Affiliation(s)
- Omar A V Mejia
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Luiz Fernando Caneo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Ricardo Ribeiro Dias
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Roberto Costa
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Fabio Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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de Melo DTP, Nerbass FB, Sayegh ALC, de Souza FR, Hotta VT, Salemi VMC, Ramires FJA, Dias RR, Lorenzi-Filho G, Mady C, Fernandes F. Impact of pericardiectomy on exercise capacity and sleep of patients with chronic constrictive pericarditis. PLoS One 2019; 14:e0223838. [PMID: 31603935 PMCID: PMC6788706 DOI: 10.1371/journal.pone.0223838] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Heart failure is associated with exercise intolerance and sleep- disordered breathing; however, studies in patients with chronic constrictive pericarditis are scarce. The purpose of our study was to assess exercise capacity and sleep in patients with chronic constrictive pericarditis (CCP) undergoing a pericardiectomy. Methods We studied consecutive patients scheduled for pericardiectomy due to symptomatic CCP. Were performed quality of life (Minnesota Living with Heart Failure Questionnaire—MLHFQ) and sleep questionnaires (Epworth, Pittsburgh Sleep Quality Index—PSQI), serum B-type natriuretic peptide (BNP), serum C-reactive protein, transthoracic echocardiography, cardiopulmonary exercise test and overnight polysomnography immediately before and six months after pericardiectomy. Results Twenty-five patients (76% males, age: 45.5±13.8 years, body mass index: 24.9±3.7 kg/m2, left ventricular ejection fraction: 60±6%) with CCP (76% idiopathic, 12% tuberculosis) were studied. As compared to the preoperative period, pericardiectomy resulted in reduction in BNP (143 (83.5–209.5) vs 76 (40–117.5) pg/mL, p = 0.011), improvement in VO2 peak (18.7±5.6 vs. 25.2±6.3 mL/kg/min, p<0.001), quality of life (MLHFQ score 62 (43,5–77,5) vs. 18 (8,5–22), p<0,001) and sleep (PSQI score 7.8±4.1 vs. 4.7±3.7, p<0.001) and no significant change in sleep disordered breathing (apnea hypopnea index—AHI 15.6 (8.3–31.7) vs. 14.6 (5.75–29.9) events/h, p = 0.253). Conclusion Patients with symptomatic CCP showed reduced exercise capacity and sleep-disordered breathing. After pericardiectomy, there was improvement in exercise capacity and neutral effect on sleep-disordered breathing.
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Affiliation(s)
- Dirceu Thiago Pessoa de Melo
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Flavia Baggio Nerbass
- Sleep Laboratory, Pulmonary Divison, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Luiza Carrari Sayegh
- Unit of Cardiovascular Rehabilitation and Exercise Physiology Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Francis Ribeiro de Souza
- Unit of Cardiovascular Rehabilitation and Exercise Physiology Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Viviane Tiemi Hotta
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Maria Curi Salemi
- Heart Failure Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Félix José Alvarez Ramires
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Unit of Cardiac Surgery, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Divison, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Charles Mady
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fábio Fernandes
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Dinato FJ, Dias RR, Duncan JA, Fernandes F, Ramires FJA, Mady C, Jatene FB. The learning curve effect on outcomes with frozen elephant trunk technique for extensive thoracic aorta disease. J Card Surg 2019; 34:796-802. [DOI: 10.1111/jocs.14139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fabrício José Dinato
- Division of Cardiovascular SurgeryHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Ricardo Ribeiro Dias
- Division of Cardiovascular SurgeryHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - José Augusto Duncan
- Division of Cardiovascular SurgeryHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Fábio Fernandes
- Clinical Unit of Myocardiopathies and Aortic DiseasesHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Felix José Alvares Ramires
- Clinical Unit of Myocardiopathies and Aortic DiseasesHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Charles Mady
- Clinical Unit of Myocardiopathies and Aortic DiseasesHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Fabio Biscegli Jatene
- Division of Cardiovascular SurgeryHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
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Arthur CPDS, Mejía OAV, Lapenna GA, Brandão CMDA, Lisboa LAF, Dias RR, Dallan LAO, Pomerantzeff PMA, Jatene FB. Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery. Braz J Cardiovasc Surg 2019; 33:618-625. [PMID: 30652752 PMCID: PMC6326452 DOI: 10.21470/1678-9741-2018-0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 01/04/2023] Open
Abstract
Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.
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Affiliation(s)
- Camila Perez de Souza Arthur
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Omar Asdrúbal Vilca Mejía
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Gisele Aparecida Lapenna
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Carlos Manuel de Almeida Brandão
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Augusto Ferreira Lisboa
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luís Alberto Oliveira Dallan
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Pablo Maria Alberto Pomerantzeff
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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16
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Gomes EN, Dias RR, Rocha BA, Santiago JAD, Dinato FJDS, Saadi EK, Gomes WJ, Jatene FB. Use of 3D Printing in Preoperative Planning and Training for Aortic Endovascular Repair and Aortic Valve Disease. Braz J Cardiovasc Surg 2019; 33:490-495. [PMID: 30517258 PMCID: PMC6257534 DOI: 10.21470/1678-9741-2018-0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/16/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction Three-dimensional (3D) printing has become an affordable tool for assisting
heart surgeons in the aorta endovascular field, both in surgical planning,
education and training of residents and students. This technique permits the
construction of physical prototypes from conventional medical images by
converting the anatomical information into computer aided design (CAD)
files. Objective To present the 3D printing feature on developing prototypes leading to
improved aortic endovascular surgical planning, as well as transcatheter
aortic valve implantation, and mainly enabling training of the surgical
procedure to be performed on patient's specific condition. Methods Six 3D printed real scale prototypes were built representing different aortic
diseases, taken from real patients, to simulate the correction of the
disease with endoprosthesis deployment. Results In the hybrid room, the 3D prototypes were examined under fluoroscopy, making
it possible to obtain images that clearly delimited the walls of the aorta
and its details. The endovascular simulation was then able to be performed,
by correctly positioning the endoprosthesis, followed by its deployment. Conclusion The 3D printing allowed the construction of aortic diseases realistic
prototypes, offering a 3D view from the two-dimensional image of computed
tomography (CT) angiography, allowing better surgical planning and surgeon
training in the specific case beforehand.
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Affiliation(s)
- Eduardo Nascimento Gomes
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Bruno Aragão Rocha
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad-HCFMUSP), São Paulo, SP, Brazil
| | - José Augusto Duncan Santiago
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabrício José de Souza Dinato
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Eduardo Keller Saadi
- Department of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Walter J Gomes
- Cardiology and Cardiovascular Surgery Disciplines, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Fernandes F, Mello DTP, Ramires FJA, Sabino EC, Moreira CHV, Benvenutti L, Hotta VT, Sayeg A, Dias RR, Mady C. P695Galectin-3 levels are normal in patients with constrictive pericarditis and are associated with exercise intolerance after pericardiectomy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F Fernandes
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - D T P Mello
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - F J A Ramires
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - E C Sabino
- Clinical Hospital of the University of Sao Paulo, Department of Infectious Disease/Institute of Tropical Medicine, University of São Paulo,, Sao Paulo, Brazil
| | - C H V Moreira
- Clinical Hospital of the University of Sao Paulo, Department of Infectious Disease/Institute of Tropical Medicine, University of São Paulo,, Sao Paulo, Brazil
| | - L Benvenutti
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - V T Hotta
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - A Sayeg
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - R R Dias
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - C Mady
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
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18
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Duncan JA, Dias RR, Dinato FJ, Fernandes F, Ramirez FJÁ, Mady C, Jatene FB. Hybrid Approach of Aortic Diseases: Zone 1 Delivery and Volumetric Analysis on the Descending Aorta. Braz J Cardiovasc Surg 2017; 32:361-366. [PMID: 29211214 PMCID: PMC5701099 DOI: 10.21470/1678-9741-2017-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/27/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction Conventional techniques of surgical correction of arch and descending aortic
diseases remains as high-risk procedures. Endovascular treatments of
abdominal and descending thoracic aorta have lower surgical risk. Evolution
of both techniques - open debranching of the arch and endovascular approach
of the descending aorta - may extend a less invasive endovascular treatment
for a more extensive disease with necessity of proximal landing zone in the
arch. Objective To evaluate descending thoracic aortic remodeling by means of volumetric
analysis after hybrid approach of aortic arch debranching and stenting the
descending aorta. Methods Retrospective review of seven consecutive patients treated between September
2014 and August 2016 for diseases of proximal descending aorta (aneurysms
and dissections) by hybrid approach to deliver the endograft at zone 1.
Computed tomography angiography were analyzed using a specific software to
calculate descending thoracic aorta volumes pre- and postoperatively. Results Follow-up was done in 100% of patients with a median time of 321 days (range,
41-625 days). No deaths or permanent neurological complications were
observed. There were no endoleaks or stent migrations. Freedom from
reintervention was 100% at 300 days and 66% at 600 days. Median volume
reduction was of 45.5 cm3, representing a median volume shrinkage
by 9.3%. Conclusion Hybrid approach of arch and descending thoracic aorta diseases is feasible
and leads to a favorable aortic remodeling with significant volume
reduction.
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Affiliation(s)
- José Augusto Duncan
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabrício José Dinato
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fábio Fernandes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Félix José Álvares Ramirez
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Fernandes F, Melo DTPD, Ramires FJA, Dias RR, Tonini M, Fernandes VDS, Rochitte CE, Moreira CHV, Mady C. Importance of Clinical and Laboratory Findings in the Diagnosis and Surgical Prognosis of Patients with Constrictive Pericarditis. Arq Bras Cardiol 2017; 109:457-465. [PMID: 28977057 PMCID: PMC5729782 DOI: 10.5935/abc.20170147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/04/2017] [Indexed: 11/20/2022] Open
Abstract
Background International studies have reported the value of the clinical profile and
laboratory findings in the diagnosis of constrictive pericarditis. However,
Brazilian population data are scarce. Objective To assess the clinical characteristics, sensitivity of imaging tests and
factors related to the death of patients with constrictive pericarditis
undergoing pericardiectomy. Methods Patients with constrictive pericarditis surgically confirmed were
retrospectively assessed regarding their clinical and laboratory variables.
Two methods were used: transthoracic echocardiography and cardiac magnetic
resonance imaging. Mortality predictors were determined by use of univariate
analysis with Cox proportional hazards model and hazard ratio. All tests
were two-tailed, and an alpha error ≤ 5% was considered statically
significant. Results We studied 84 patients (mean age, 44 ± 17.9 years; 67% male). Signs
and symptoms of predominantly right heart failure were present with jugular
venous distention, edema and ascites in 89%, 89% and 62% of the cases,
respectively. Idiopathic etiology was present in 69.1%, followed by
tuberculosis (21%). Despite the advanced heart failure degree, low BNP
levels (median, 157 pg/mL) were found. The diagnostic sensitivities for
constriction of echocardiography and magnetic resonance imaging were 53.6%
and 95.9%, respectively. There were 9 deaths (10.7%), and the risk factors
were: anemia, BNP and C reactive protein levels, pulmonary hypertension
>55 mm Hg, and atrial fibrillation. Conclusions Magnetic resonance imaging had better diagnostic sensitivity. Clinical,
laboratory and imaging markers were associated with death.
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Affiliation(s)
- Fábio Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Dirceu Thiago Pessoa de Melo
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Felix José Alvarez Ramires
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Ricardo Ribeiro Dias
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Marcio Tonini
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Vinicius Dos Santos Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | - Charles Mady
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Dias RR, Duncan JA, de Souza Dinato FJ, Araújo LL, Issa HMN, Fernandes F, Mady C, Jatene FB. Does aortic valve repair in valve-sparing aortic root reconstruction compromise the longevity of the procedure? Clinics (Sao Paulo) 2017; 72:207-212. [PMID: 28492719 PMCID: PMC5401616 DOI: 10.6061/clinics/2017(04)03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/12/2016] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES: The effect of performing aortic valve repair in combination with valve-sparing operation on the length of time for which patients are free from reoperation is unclear. The objective of this study was to determine if the performance of aortic valve repair during valve-sparing operation modified the freedom from reoperation time. METHODS: From January 2003 to July 2014, 78 patients with a mean age of 49±15 years underwent valve-sparing operation. Sixty-eight percent of these patients were male. Twenty-two (28%) aortic valve repair procedures were performed in this patient population. In the aortic valve repair + valve-sparing operation group, 77.3% of patients had moderate/severe aortic insufficiency, while in the valve-sparing operation group, 58.6% of patients had moderate/severe aortic insufficiency (ns = not significant). Additionally, 13.6% of patients in the aortic valve repair + valve-sparing operation group had functional class III/IV, while 14.2% of patients in the valve-sparing operation group had functional class III/IV (ns). RESULTS: The in-hospital and late mortality rates, for the aortic valve repair + valve-sparing operation and valve-sparing operation groups were similar, as they were 4.5% and 3.6%; and 0% and 1.8%, respectively. In the aortic valve repair + valve-sparing operation group, 0% of patients presented moderate/severe aortic insufficiency during late follow-up, while in the valve-sparing operation group, 14.2% of patients presented with moderate/severe aortic insufficiency during this period (ns). In the aortic valve repair + valve-sparing operation group, 5.3% of patients presented with functional class III/IV, while in the valve-sparing operation group, 4.2% of patients presented with functional class III/IV (ns). In the aortic valve repair + valve-sparing operation group, 0% of patients required reoperation, while in the valve-sparing operation group, 3.6% of patients required reoperation over a mean follow-up period of 1621±1156 days (75 patients). CONCLUSION: Valve-sparing operation is a safe and long-lasting procedure and performance of aortic valve repair when necessary does not increase risk of reoperation on the aortic valve.
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Affiliation(s)
- Ricardo Ribeiro Dias
- Cirurgia Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Augusto Duncan
- Cirurgia Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fabrício José de Souza Dinato
- Cirurgia Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Lucas Lacerda Araújo
- Cirurgia Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hugo Monteiro Neder Issa
- Cirurgia Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fábio Fernandes
- Cirurgia Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Charles Mady
- Cirurgia Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fábio Biscegli Jatene
- Cirurgia Cardiovascular, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Weber TR, Hotta VT, Rochitte CE, Staszko KF, Dias RR, Mady C. Complication of hybrid treatment in type B aortic dissection diagnosed by echocardiography. Echocardiography 2017; 34:794-795. [PMID: 28345251 DOI: 10.1111/echo.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This case illustrates an unusual and fatal complication after endovascular treatment of type B aortic dissection and highlights the role of echocardiography in the early diagnosis of complications. In this case, a patient with previous diagnosis of chronic type B aortic dissection and moderate aortic regurgitation underwent endovascular repair of the proximal descending aorta and conservative surgical correction of the aortic valve. On early postoperative, a transesophageal echocardiogram and aortic angiotomography demonstrated proximal endoleak by contrast extravasation around the proximal graft attachment site, causing compression of the stent in its middle portion, resulting in narrowing with reduced cross-sectional area.
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Affiliation(s)
| | - Viviane Tiemi Hotta
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.,Fleury, São Paulo, Brazil
| | | | | | | | - Charles Mady
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
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Khalil KH, Palma JH, Simonato M, Dias RR, Jatene F. When Aortic Stenting Alone Does Not Solve It: Mass Effect of Thoracic Aneurysms. Ann Vasc Surg 2016; 39:284.e11-284.e13. [PMID: 27521829 DOI: 10.1016/j.avsg.2016.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/15/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
Thoracic aneurysms can potentially cause substantial compression of adjacent structures, creating substantial symptoms. We present a case of a 56-year-old woman with fatigue and dyspnea for 6 months. We discuss her initial endovascular treatment, which was insufficient to improve symptoms, and further surgical intervention was needed to solve the issue.
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Affiliation(s)
- Kalil Hussein Khalil
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jose Honorio Palma
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | | | - Ricardo Ribeiro Dias
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Jatene
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Chrifi I, Dierick F, Dumitriu IE, Schuchardt M, Jover E, Yan Z, Fontijn RD, Borges L, Brandt MM, Cheng C, Duncker DJGM, Monceau V, Hoareau B, Mougenot N, Marazzi G, Sassoon D, Hulot JS, Soubrier F, Nadaud S, Baruah P, Dinkla S, Bullenkamp J, Kaski JC, Tu Y, Pruefer N, Toelle M, Chebli S, Zidek W, Van Der Giet M, Silvente A, Marin F, Rodriguez C, Martinez-Gonzalez J, Puche CM, Valdes M, Hernandez Romero D, Tan J, Yang L, Valent ET, Leyen TA, Szulcek R, Baggen JM, Geerts D, Van Nieuw Amerongen GP, Horrevoets AJG, Alvarenga LAA, Falcao RSP, Dias RR, Lacchini S, Gutierrez PS, Michel JB. Moderated Poster session - Vascular26Identification of CMTM3 as a new pro-angiogenic factor essential for vessel stabilization27Regulation of pulmonary vascular PW1+ progenitor cells recruitment during early chronic hypoxia-induced vessel neomuscularization28Impaired interleukin-10 production in response to CpG and depletion of the regulatory CD19+CD24hiCD38hi B cell compartment in patients with coronary atherosclerosis29Inflammatory effects of serum amyloid A via TLR2 and TLR4 in vascular cells30Collagen cross-linking enzymes are involved in vascular smooth muscle cells calcification31miR-504 inhibits venous smooth muscle cell proliferation and migration by targeting LAMTOR132Diaphenous related formin 2 (DRF2) is essential for KLF2-induced resistance of endothelial cells to flow forces.33Inhibition of TGfb axis and renin-angiotensin system in human ascending aorta aneurysms. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw133] [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: 11/12/2022] Open
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Garcia-Martinez V, Lopez Sanchez C, Hamed W, Hamed W, Hsu JH, Ferrer-Lorente R, Alshamrani M, Pizzicannella J, Vindis C, Badi I, Korte L, Voellenkle C, Niculescu LS, Massaro M, Babaeva AR, Da Silva F, Woudstra L, Berezin A, Bae MK, Del Giudice C, Bageghni SA, Krobert K, Levay M, Vignier N, Ranieri A, Magenta A, Orlandi A, Porro B, Jeon ES, Omori Y, Herold J, Barnett GA, Grochot-Przeczek A, Korpisalo P, Deffge C, Margariti A, Rong W, Maring JA, Gambardella J, Mitrofan CG, Karpinska O, Morbidelli L, Wilkinson FL, Berezin A, Kostina AS, De Mey JGR, Kumar A, Lupieri A, Pellet-Many C, Stamatiou R, Gromotowicz A, Dickhout A, Murina M, Roka-Moiia YM, Malinova L, Diaz-Canestro C, Vigliarolo T, Cuzzocrea S, Szantai A, Medic B, Cassambai S, Korda A, Revnic CR, Borile G, Diokmetzidou A, Murfitt L, Budko A, Fiordelisi A, De Wijs-Meijler DPM, Gevaert AB, Noriega De La Colina A, Benes J, Guillermo Solache Berrocal GSB, Gafarov V, Zhebel VM, Prakaschandra R, Stepien EL, Smith LE, Carluccio MA, Timasheva Y, Paci M, Dorofeyeva NA, Chimed CH, Petelina TI, Sorop O, Genis A, Parepa IR, Tscharre M, Krestjyaninov MV, Maia-Rocha C, Borges L, Sasonko ML, Kapel SS, Stam K, Sommariva E, Stojkovic S, O'reilly J, Chiva-Blanch G, Malinova L, Evtushenko A, Skopal J, Sunderland N, Gegenava T, Charnaia MA, Di Lascio N, Tarvainen SJ, Malandraki-Miller S, Uitterdijk A, Benzoni P, Ruivo E, Humphrey EJ, Arokiaraj MC, Franco D, Garcia-Lopez V, Aranega A, Lopez-Sanchez C, Franco D, Garcia-Lopez V, Aranega A, Garcia-Martinez V, Tayel S, Khader H, El-Helbawy N, Tayel S, Alrefai A, El-Barbary H, Wu JR, Dai ZK, Yeh JL, Sanjurjo-Rodriguez C, Richaud-Patin Y, Blanco FJ, Badimon L, Raya A, Cahill PA, Diomede F, Merciaro I, Trubiani O, Nahapetyan H, Swiader A, Faccini J, Boya P, Elbaz M, Zeni F, Burba I, Bertolotti M, Capogrossi MC, Pompilio G, Raucci A, Widmer-Teske R, Dutzmann J, Bauersachs J, Donde K, Daniel JM, Sedding DG, Simionescu N, Sanda GM, Carnuta MG, Stancu CS, Popescu AC, Popescu MR, Vlad A, Dimulescu DR, Sima AV, Scoditti E, Pellegrino M, Calabriso N, Carluccio MA, Storelli C, De Caterina R, Solodenkova KS, Kalinina EV, Usachiova MN, Lappalainen J, Lee-Rueckert MDEC, Kovanen PT, Biesbroek PS, Emmens RWE, Van Rossum AC, Juffermans LJM, Niessen JWM, Krijnen PAJ, Kremzer A, Samura T, Berezina T, Gronenko E, Kim MK, Park HJ, Bae SK, Sorriento D, Ciccarelli M, Vernieri E, Campiglia P, Trimarco B, Iaccarino G, Hemmings KE, Porter KE, Ainscough JF, Drinkhill MJ, Turner NA, Hiis HG, Cosson MV, Levy FO, Wieland T, Macquart C, Chatzifrangkeskou M, Evans A, Bonne G, Muchir A, Kemp E, Avkiran M, Carlomosti F, D'agostino M, Beji S, Zaccagnini G, Maimone B, Di Stefano V, De Santa F, Cordisco S, Antonini A, Ciarapica R, Dellambra E, Martelli F, Avitabile D, Capogrossi MC, Scioli MG, Bielli A, Agostinelli S, Tarquini C, Tarallo V, De Falco S, Zaninoni A, Fiorelli S, Bianchi P, Teruzzi G, Squellerio I, Turnu L, Lualdi A, Tremoli E, Cavalca V, Lee YJ, Ju ES, Choi JO, Lee GY, Lim BK, Manickam MANOJ, Jung SH, Omiya S, Otsu K, Deffge C, Nowak S, Wagner M, Braun-Dullaeus RC, Kostin S, Daniel JM, Francke A, Subramaniam S, Kanse SM, Al-Lamee K, Schofield CJ, Egginton S, Gershlick AH, Kloska D, Kopacz A, Augustyniak A, Dulak J, Jozkowicz A, Hytonen J, Halonen P, Taavitsainen J, Tarvainen S, Hiltunen T, Liimatainen T, Kalliokoski K, Knuuti J, Yla-Herttuala S, Wagner M, Weinert S, Isermann B, Lee J, Braun-Dullaeus RC, Herold J, Cochrane A, Kelaini S, Bojdo J, Vila Gonzalez M, Hu Y, Grieve D, Stitt AW, Zeng L, Xu Q, Margariti A, Reglin B, Xiang W, Nitzsche B, Maibier M, Pries AR, Vrijsen KR, Chamuleau SAJ, Verhage V, Metz CHG, Lodder K, Van Eeuwijk ECM, Van Dommelen SM, Doevendans PA, Smits AM, Goumans MJ, Sluijter JPG, Sorriento D, Bova M, Loffredo S, Trimarco B, Iaccarino G, Ciccarelli M, Appleby S, Morrell N, Baranowska-Kuczko M, Kloza M, Ambrozewicz E, Kozlowski M, Malinowska B, Kozlowska H, Monti M, Terzuoli E, Ziche M, Mahmoud AM, Jones AM, Wilkinson JA, Romero M, Duarte J, Alexander MY, Kremzer A, Berezina T, Gronenko E, Faggian G, Kostareva AA, Malashicheva AB, Leurgans TM, Nguyen TN, Irmukhamedov A, Riber LP, Mcgeogh R, Comer S, Blanco Fernandez A, Ghigo A, Blaise R, Smirnova NF, Malet N, Vincent P, Limon I, Gayral S, Hirsch E, Laffargue M, Mehta V, Zachary I, Aidonidis I, Kramkowski K, Miltyk W, Kolodziejczyk P, Gradzka A, Szemraj J, Chabielska E, Dijkgraaf I, Bitsch N, Van Hoof S, Verhaegen F, Koenen R, Hackeng TM, Roshchupkin DI, Buravleva KV, Sergienko VI, Zhernossekov DD, Rybachuk VM, Grinenko TV, Furman N, Dolotovskaya P, Shamyunov M, Denisova T, Reiner M, Akhmedov A, Keller S, Miranda M, Briand S, Barile L, Kullak-Ublick G, Luscher T, Camici G, Guida L, Magnone M, Ameri P, Lazzarini E, Fresia C, Bruzzone S, Zocchi E, Di Paola R, Cordaro M, Crupi R, Siracusa R, Campolo M, Bruschetta G, Fusco R, Pugliatti P, Esposito E, Paloczi J, Ruivo E, Gaspar R, Dinnyes A, Kobolak J, Ferdinandy P, Gorbe A, Todorovic Z, Krstic D, Savic Vujovic K, Jovicic D, Basta Jovanovic G, Radojevic Skodric S, Prostran M, Dean S, Mee CJ, Harvey KL, Hussain A, Pena C, Paltineanu B, Voinea S, Revnic F, Ginghina C, Zaglia T, Ceriotti P, Campo A, Carullo P, Armani A, Coppini R, Vida V, Olivotto I, Stellin G, Rizzuto R, De Stefani D, Sandri M, Catalucci D, Mongillo M, Soumaka E, Kloukina I, Tsikitis M, Makridakis M, Varela A, Davos C, Vlachou A, Capetanaki Y, Iqbal MM, Bennett H, Davenport B, Pinali C, Cooper G, Cartwright E, Kitmitto A, Strutynska NA, Mys LA, Sagach VF, Franco A, Sorriento D, Trimarco B, Iaccarino G, Ciccarelli M, Verzijl A, Stam K, Van Duin R, Reiss IKM, Duncker DJ, Merkus D, Shakeri H, Orije M, Leloup AJ, Van Hove CE, Van Craenenbroeck EM, De Meyer GRY, Vrints CJ, Lemmens K, Desjardins-Creapeau L, Wu R, Lamarre-Cliche M, Larochelle P, Bherer L, Girouard H, Melenovsky M, Kvasilova A, Benes J, Ruskova K, Sedmera D, Ana Barral ABV, Martin Fernandez M, Pablo Roman Garcia PRG, Juan Carlos Llosa JCLL, Manuel Naves Diaz MND, Cesar Moris CM, Jorge B Cannata-Andia JBCA, Isabel Rodriguez IR, Voevoda M, Gromova E, Maximov V, Panov D, Gagulin I, Gafarova A, Palahniuk H, Pashkova IP, Zhebel NV, Starzhynska OL, Naidoo DP, Rawojc K, Enguita FJ, Grudzien G, Cordwell SJ, White MY, Massaro M, Scoditti E, Calabriso N, Pellegrino M, Martinelli R, Gatta V, De Caterina R, Nasibullin TR, Erdman VV, Tuktarova IA, Mustafina OE, Hyttinen J, Severi S, Vorobyov GG, Sagach VF, Batmyagmar KH, Lkhagvasuren Z, Gapon LI, Musikhina NA, Avdeeva KS, Dyachkov SM, Heinonen I, Van Kranenburg M, De Beer VJ, Octavia Y, Van Geuns RJ, Van Den Meiracker AH, Van Der Velden J, Merkus D, Duncker DJ, Everson FP, Ogundipe T, Grandjean T, De Boever P, Goswami N, Strijdom H, Suceveanu AI, Suceveanu AP, Mazilu L, Tofoleanu DE, Catrinoiu D, Rohla M, Hauser C, Huber K, Wojta H, Weiss TW, Melnikova MA, Olezov NV, Gimaev RH, Khalaf H, Ruzov VI, Adao R, Mendes-Ferreira P, Santos-Ribeiro D, Rademaker M, Leite-Moreira AF, Bras-Silva C, Alvarenga LAA, Falcao RSP, Dias RR, Lacchini S, Gutierrez PS, Michel JB, Gurfinkel YUI, Atkov OYU, Teichert M, Korn C, Mogler C, Hertel S, Arnold C, Korff T, Augustin HG, Van Duin RWB, De Wijs-Meijler DPM, Verzijl A, Duncker DJ, Merkus D, D'alessandra Y, Farina FM, Casella M, Catto V, Carbucicchio C, Dello Russso A, Stadiotti I, Brambilla S, Chiesa M, Giacca M, Colombo GI, Pompilio G, Tondo C, Ahlin F, Andric T, Tihanyi D, Wojta J, Huber K, O'connell E, Butt A, Murphy L, Pennington S, Ledwidge M, Mcdonald K, Baugh J, Watson C, Suades R, Crespo J, Estruch R, Badimon L, Dyachenko A, Ryabukho V, Evtushenko V, Saushkina YU, Lishmanov YU, Smyshlyaev K, Bykov A, Popov S, Pavlyukova E, Anfinogenova Y, Szigetfu E, Kapornai B, Forizs E, Jenei ZS, Nagy Z, Merkely B, Zima E, Cai A, Dworakowski R, Gibbs T, Piper S, Jegard N, Mcdonagh T, Gegenava M, Dementieva II, Morozov YUA, Barsanti C, Stea F, Lenzarini F, Kusmic C, Faita F, Halonen PJ, Puhakka PH, Hytonen JP, Taavitsainen JM, Yla-Herttuala S, Supit EA, Carr CA, Groenendijk BCW, Gorsse-Bakker C, Panasewicz A, Sneep S, Tempel D, Van Der Giessen WJ, Duncker DJ, Rys J, Daraio C, Dell'era P, Paloczi J, Pigler J, Eder A, Ferdinandy P, Eschenhagen T, Gorbe A, Mazo MM, Amdursky N, Peters NS, Stevens MM, Terracciano CM. Poster session 2Morphogenetic mechanisms290MiR-133 regulates retinoic acid pathway during early cardiac chamber specification291Bmp2 regulates atrial differentiation through miR-130 during early heart looping formationDevelopmental genetics294Association of deletion allele of insertion/deletion polymorphism in alpha 2B adrenoceptor gene and hypertension with or without type 2 diabetes mellitus295Association of G1359A polymorphism of the endocannabinoid type 1 receptor (CNR1) with coronary artery disease (CAD) with type 2 diabetes mellitusCell growth, differentiation and stem cells - Vascular298Gamma-secretase inhibitor prevents proliferation and migration of ductus arteriosus smooth muscle cells: a role of Notch signaling in postnatal closure of ductus arteriosus299Mesenchymal stromal-like cells (MLCs) derived from induced pluripotent stem (iPS) cells: a promising therapeutic option to promote neovascularization300Sonic Hedgehog promotes mesenchymal stem cell differentiation to vascular smooth muscle cells in cardiovacsular disease301Proinflammatory cytokine secretion and epigenetic modification in endothelial cells treated LPS-GinfivalisCell death and apoptosis - Vascular304Mitophagy acts as a safeguard mechanism against human vascular smooth muscle cell apoptosis induced by atherogenic lipidsTranscriptional control and RNA species - Vascular307MicroRNA-34a role in vascular calcification308Local delivery of a miR-146a inhibitor utilizing a clinically applicable approach attenuates neointima formation after vascular injury309Long noncoding RNA landscape of hypoxic endothelial cells310Specific circulating microRNAs levels associate with hypertension, hyperglycemia and dysfunctional HDL in acute coronary syndrome patientsCytokines and cellular inflammation - Vascular313Phosphodiesterase5A up-regulation in vascular endothelium under pro-inflammatory conditions: a newly disclosed anti-inflammatory activity for the omega-3polyunsaturated aatty acid docosahexaenoic acid314Cardiovascular risk modifying with extra-low dose anticytokine drugs in rhematoid arthritis315Conversion of human M-CSF macrophages into foam cells reduces their proinflammatory responses to classical M1-polarizing activation316Lymphocytic myocarditis coincides with increased plaque inflammation and plaque hemorrhage in coronary arteries, facilitating myocardial infarction317Serum osteoprotegerin level predictsdeclined numerous of circulating endothelial- derived and mononuclear-derived progenitor cells in patients with metabolic syndromeGrowth factors and neurohormones - Vascular320Effect of gastrin-releasing peptide (GRP) on vascular inflammationSignal transduction - Heart323A new synthetic peptide regulates hypertrophy in vitro through means of the inhibition of nfkb324Inducible fibroblast-specific knockout of p38 alpha map kinase is cardioprotective in a mouse model of isoproterenol-induced cardiac hypertrophy325Regulation of beta-adrenoceptor-evoked inotropic responses by inhibitory G protein, adenylyl cyclase isoforms 5 and 6 and phosphodiesterases326Binding to RGS3 and stimulation of M2 muscarinic acetylcholine receptors modulates the substrate specificity of p190RhoGAP in cardiac myocytes327Cardiac regulation of post-translational modifications, parylation and deacetylation in LMNA dilated cardiomyopathy mouse model328Beta-adrenergic regulation of the b56delta/pp2a holoenzyme in cardiac myocytes through b56delta phosphorylation at serine 573Nitric oxide and reactive oxygen species - Vascular331Oxidative stress-induced miR-200c disrupts the regulatory loop among SIRT1, FOXO1 and eNOS332Antioxidant therapy prevents oxidative stress-induced endothelial dysfunction and Enhances Wound Healing333Morphological and biochemical characterization of red blood cell in coronary artery diseaseCytoskeleton and mechanotransduction - Heart336Novel myosin activator, JSH compounds, increased myocardial contractility without chronotropic effect in ratsExtracellular matrix and fibrosis - Vascular339Ablation of Toll-like receptor 9 causes cardiac rupture after myocardial infarction by attenuating proliferation and differentiation of cardiac fibroblasts340Altered vascular remodeling in the mouse hind limb ischemia model in Factor VII activating protease (FSAP) deficiencyVasculogenesis, angiogenesis and arteriogenesis343Pro-angiogenic effects of proly-hydroxylase inhibitors and their potential for use in a novel strategy of therapeutic angiogenesis for coronary total occlusion344Nrf2 drives angiogenesis in transcription-independent manner: new function of the master regulator of oxidative stress response345Angiogenic gene therapy, despite efficient vascular growth, is not able to improve muscle function in normoxic or chronically ischemic rabbit hindlimbs -role of capillary arterialization and shunting346Effect of PAR-1 inhibition on collateral vessel growth in the murine hind limb model347Quaking is a key regulator of endothelial cell differentiation, neovascularization and angiogenesis348"Emerging angiogenesis" in the chick chorioallantoic membrane (CAM). An in vivo study349Exosomes from cardiomyocyte progenitor cells and mesenchymal stem cells stimulate angiogenesis in vitro and in vivo via EMMPRINEndothelium352Reciprocal regulation of GRK2 and bradykinin receptor stimulation modulate Ca2+ intracellular level in endothelial cells353The roles of bone morphogenetic proteins 9 and 10 in endothelial inflammation and atherosclerosis354The contribution of GPR55 to the L-alpha-lysophosphatidylinositol-induced vasorelaxation in isolated human pulmonary arteries355The endothelial protective ACE inhibitor Zofenoprilat exerts anti-inflammatory activities through H2S production356A new class of glycomimetic drugs to prevent free fatty acid-induced endothelial dysfunction357Endothelial progenitor cells to apoptotic endothelial cell-derived microparticles ration differentiatesas preserved from reduced ejection fractionheart failure358Proosteogenic genes are activated in endothelial cells of patients with thoracic aortic aneurysm359Endothelin ETB receptors mediate relaxing responses to insulin in pericardial resistance arteries from patients with cardiovascular disease (CVD)Smooth muscle and pericytes362CX3CR1 positive myeloid cells regulate vascular smooth muscle tone by inducing calcium oscillations via activation of IP3 receptors363A novel function of PI3Kg on cAMP regulation, role in arterial wall hyperplasia through modulation of smooth muscle cells proliferation364NRP1 and NRP2 play important roles in the development of neointimal hyperplasia in vivo365Azithromycin induces autophagy in aortic smooth muscle cellsCoagulation, thrombosis and platelets368The real time in vivo evaluation of platelet-dependent aldosterone prothrombotic action in mice369Development of a method for in vivo detection of active thrombi in mice370The antiplatelet effects of structural analogs of the taurine chloramine371The influence of heparin anticoagulant drugs on functional state of human platelets372Regulation of platelet aggregation and adenosine diphosphate release by d dimer in acute coronary syndrome (in vitro study)Oxygen sensing, ischaemia and reperfusion375Sirtuin 5 mediates brain injury in a mouse model of cerebral ischemia-reperfusion376Abscisic acid: a new player in cardiomyocyte protection from ischaemia?377Protective effects of ultramicronized palmitoylethanolamide (PEA-um) in myocardial ischaemia and reperfusion injury in vivo378Identification of stem cell-derived cardiomyocytes using cardiac specific markers and additional testing of these cells in simulated ischemia/reperfusion system379Single-dose intravenous metformin treatment could afford significant protection of the injured rat kidney in an experimental model of ischemia-reperfusion380Cardiotoxicity of long acting muscarinic receptor antagonists used for chronic obstructive pulmonary disease381Dependence antioxidant potential on the concentration of amino acids382The impact of ischemia-reperfusion on physiological parameters,apoptosis and ultrastructure of rabbit myocardium with experimental aterosclerosisMitochondria and energetics385MicroRNA-1 dependent regulation of mitochondrial calcium uniporter (MCU) in normal and hypertrophied hearts386Mitochondrial homeostasis and cardioprotection: common targets for desmin and aB-crystallin387Overexpression of mitofusin-2 (Mfn2) and associated mitochondrial dysfunction in the diabetic heart388NO-dependent prevention of permeability transition pore (MPTP) opening by H2S and its regulation of Ca2+ accumulation in rat heart mitochondria389G protein coupled receptor kinase 2 (GRK2) is fundamental in recovering mitochondrial morphology and function after exposure to ionizing radiation (IR)Gender issues392Sex differences in pulmonary vascular control; focus on the nitric oxide pathwayAging395Heart failure with preserved ejection fraction develops when feeding western diet to senescence-accelerated mice396Cardiovascular markers as predictors of cognitive decline in elderly hypertensive patients397Changes in connexin43 in old rats with volume overload chronic heart failureGenetics and epigenetics400Calcium content in the aortic valve is associated with 1G>2G matrix metalloproteinase 1 polymorphism401Neuropeptide receptor gene s (NPSR1) polymorphism and sleep disturbances402Endothelin-1 gene Lys198Asn polymorphism in men with essential hypertension complicated and uncomplicated with chronic heart failure403Association of common polymorphisms of the lipoprotein lipase and pon1 genes with the metabolic syndrome in a sample of community participantsGenomics, proteomics, metabolomics, lipidomics and glycomics405Gene expression quantification using multiplexed color-coded probe pairs to determine RNA content in sporadic cardiac myxoma406Large-scale phosphorylation study of the type 2 diabetic heart subjected to ischemia / reperfusion injury407Transcriptome-based identification of new anti-inflammatory properties of the olive oil hydroxytyrosol in vascular endothelial cell under basal and proinflammatory conditions408Gene polymorphisms combinations and risk of myocardial infarctionComputer modelling, bioinformatics and big data411Comparison of the repolarization reserve in three state-of-the-art models of the human ventricular action potentialMetabolism, diabetes mellitus and obesity414Endothelial monocyte-activating polypeptide-II improves heart function in type -I Diabetes mellitus415Admission glucose level is independent predictor of impaired left ventricular function in patients with acute myocardial infarction: a two dimensional speckle-tracking echocardiography study416Association between biochemical markers of lipid profile and inflammatory reaction and stiffness of the vascular wall in hypertensive patients with abdominal obesity417Multiple common co-morbidities produce left ventricular diastolic dysfunction associated with coronary microvascular dysfunction, oxidative stress and myocardial stiffening418Investigating the cardiovascular effects of antiretroviral drugs in a lean and high fat/sucrose diet rat model of obesity419Statins in the treatment of non-alcoholic steatohepatitis (NASH). Our experience from a 2-year prospective study in Constanta County, Romania420Epicardial adipose tissue as a predictor of cardiovascular outcome in patients with ACS undergoing PCI?Arterial and pulmonary hypertension423Dependence between heart rhythm disorers and ID polymorphism of ACE gene in hypertensive patients424Molecular mechanisms underlying the beneficial effects of Urocortin 2 in pulmonary arterial hypertension425Inhibition of TGf-b axis and action of renin-angiotensin system in human ascending aorta aneurysms426Early signs of microcirculation and macrocirculation abnormalities in prehypertension427Vascular smooth muscle cell-expressed Tie-2 controls vascular tone428Cardiac and vascular remodelling in the development of chronic thrombo-embolic pulmonary hypertension in a novel swine modelBiomarkers431Arrhythmogenic cardiomyopathy: a new, non invasive biomarker432Can circulating microRNAs distinguish type 1 and type 2 myocardial infarction?433Design of a high-throughput multiplex proteomics assay to identify left ventricular diastolic dysfunction in diabetes434Monocyte-derived and P-selectin-carrying microparticles are differently modified by a low fat diet in patients with cardiovascular risk factors who will and who will not develop a cardiovascular event435Red blood cell distribution width assessment by polychromatic interference microscopy of thin films in chronic heart failure436Invasive and noninvasive evaluation of quality of radiofrequency-induced cardiac denervation in patients with atrial fibrillation437The effect of therapeutic hypothermia on the level of brain derived neurotrophic factor (BDNF) in sera following cardiopulmonary resustitation438Novel biomarkers to predict outcome in patients with heart failure and severe aortic stenosis439Biological factors linking depression and anxiety to cardiovascular disease440Troponins and myoglobin dynamic at coronary arteries graftingInvasive, non-invasive and molecular imaging443Diet composition effects on the genetic typing of the mouse ob mutation: a micro-ultrasound characterization of cardiac function, macro and micro circulation and liver steatosis444Characterization of pig coronary and rabbit aortic lesions using IV-OCT quantitative analysis: correlations with histologyGene therapy and cell therapy447Enhancing the survival and angiogenic potential of mouse atrial mesenchymal cells448VCAM-1 expression in experimental myocardial infarction and its relation to bone marrow-derived mononuclear cell retentionTissue engineering451Advanced multi layered scaffold that increases the maturity of stem cell-derived human cardiomyocytes452Response of engineered heart tissue to simulated ischemia/reperfusion in the presence of acute hyperglycemic conditions453Serum albumin hydrogels prevent de-differentiation of neonatal cardiomyocytes454A novel paintbrush technique for transfer of low viscosity ultraviolet light curable cyan methacrylate on saline immersed in-vitro sheep heart. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dias RR, Duncan JA. Answer to "Key points of reducing neurologic complications in frozen elephant trunk technique". Braz J Cardiovasc Surg 2016; 30:506. [PMID: 27163430 PMCID: PMC4614939 DOI: 10.5935/1678-9741.20150057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Aparecida-Silva R, Borges LF, Kessler K, Dias RR, Moreira LFP, Kalil J, Gutierrez PS. Transforming growth factor-β1 SMAD effectors and medial cell number in ascending aorta diseases. Cardiovasc Pathol 2016; 25:240-246. [DOI: 10.1016/j.carpath.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 10/22/2022] Open
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Lamana FDA, Dias RR, Duncan JA, Faria LBD, Malbouisson LMS, Borges LDF, Mady C, Jatene FB. Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients? Braz J Cardiovasc Surg 2016; 30:343-52. [PMID: 26313725 PMCID: PMC4541781 DOI: 10.5935/1678-9741.20150028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 04/26/2015] [Indexed: 12/05/2022] Open
Abstract
Objective To compare the results of the root reconstruction with the aortic valve-sparing
operation versus composite graftvalve replacement. Methods From January 2002 to October 2013, 324 patients underwent aortic root
reconstruction. They were 263 composite graft-valve replacement and 61 aortic
valve-sparing operation (43 reimplantation and 18 remodeling). Twenty-six percent
of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome,
and 12% had bicuspid aortic valve. There was a predominance of aneurysms over
dissections (81% vs. 19%), with 7% being acute dissections. The complete follow-up
of 100% of the patients was performed with median follow-up time of 902 days for
patients undergoing composite graft-valve replacement and 1492 for those
undergoing aortic valve-sparing operation. Results In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve
replacement and aortic valve-sparing operation (ns). During the late follow-up
period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA
functional class I and II were 89.4% and 94%, respectively for composite
graft-valve replacement and aortic valve-sparing operation (ns). Root
reconstruction with aortic valve-sparing operation showed lower late mortality
(P=0.001) and lower bleeding complications
(P=0.006). There was no difference for thromboembolism,
endocarditis, and need of reoperation. Conclusion The aortic root reconstruction with preservation of the valve should be the
operation being performed for presenting lower late mortality and survival free of
bleeding events.
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Affiliation(s)
| | - Ricardo Ribeiro Dias
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Jose Augusto Duncan
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | | | | | - Luciano de Figueiredo Borges
- Departament of Morfology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR
| | - Charles Mady
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Fábio Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
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Dias RR, Duncan JA, Vianna DS, de Faria LB, Fernandes F, Ramirez FJÁ, Mady C, Jatene FB. Surgical treatment of complex aneurysms and thoracic aortic dissections with the Frozen Elephant Trunk technique. Braz J Cardiovasc Surg 2016; 30:205-10. [PMID: 26107452 PMCID: PMC4462966 DOI: 10.5935/1678-9741.20140119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/13/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Report initial experience with the Frozen Elephant Trunk technique. METHODS From July 2009 to October 2013, Frozen Elephant Trunk technique was performed in 21 patients (66% male, mean age 56 ± 11 years). They had type A aortic dissection (acute 9.6%, chronic 57.3%), type B (14.3%, all chronic) and complex aneurysms (19%). It was 9.5% of reoperations and 38% of associated procedures (25.3% miocardial revascularization, 25.3% replacement of aortic valve and 49.4% aortic valved graft). Aortic remodeling was evaluated comparing preoperative and most recent computed tomography scans. One hundred per cent of complete follow-up, mean time of 28 months. RESULTS In-hospital mortality of 14.2%, being 50% in acute type A aortic dissection, 8.3% in chronic type A aortic dissection, 33.3% in chronic type B aortic dissection and 0% in complex aneurysms. Mean times of cardiopulmonary bypass (152 ± 24 min), myocardial ischemia (115 ± 31 min) and selective cerebral perfusion (60 ± 15 min). Main complications were bleeding (14.2%), spinal cord injury (9.5%), stroke (4.7%), prolonged mechanical ventilation (4.7%) and acute renal failure (4.7%). The need for second-stage operation was 19%. False-lumen thrombosis was obtained in 80%. CONCLUSION Frozen Elephant Trunk is a feasible technique and should be considered. The severity of the underlying disease justifies high mortality rates. The learning curve is a reality. This approach allows treatment of more than two segments at once. Nonetheless, if a second stage is made necessary, it is facilitated.
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Affiliation(s)
| | | | - Diego Sarty Vianna
- Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | | | - Fábio Fernandes
- Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | | | - Charles Mady
- Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
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Hotta VT, Barros PGDM, Gutierrez PS, Bolonhez ACP, Mathias W, Dias RR. Acute Myocardial Infarction and Severe Prosthetic Dysfunction after Bentall Procedure. Arq Bras Cardiol 2015; 104:e58-60. [PMID: 26131696 PMCID: PMC4484686 DOI: 10.5935/abc.20140199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/28/2014] [Indexed: 11/20/2022] Open
Affiliation(s)
- Viviane Tiemi Hotta
- InCor, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Wilson Mathias
- InCor, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Atik E, Dias RR, Andrade JL. Case 5 / 2014 - 26-year-old male with moderate stenosis of bivalved aortic valve and dilation of ascending aorta. Arq Bras Cardiol 2014; 103:e20-1. [PMID: 25211316 PMCID: PMC4150670 DOI: 10.5935/abc.20140084] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 07/30/2013] [Indexed: 11/20/2022] Open
Affiliation(s)
- Edmar Atik
- Mailing Address: Edmar Atik, Rua Dona Adma Jafet, 74, conj.73, Bela
Vista. Postal Code 01308-050, São Paulo, SP - Brazil. E-mail:
,
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Borges LF, Diniz LT, Mello GDR, Dias RR, Gutierrez PS, Michel JB. P244The possible modulating role of protease nexin 1 and plasmin/plasmingen associated to ldl receptor-related protein-1 in the pathogenesis of human ascending aortic aneurysm. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.176] [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: 11/13/2022] Open
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Dias RR, Fernandes F, Ramires FJA, Mady C, Albuquerque CP, Jatene FB. Mortality and embolic potential of cardiac tumors. Arq Bras Cardiol 2014; 103:13-8. [PMID: 25029470 PMCID: PMC4126756 DOI: 10.5935/abc.20140096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/14/2014] [Indexed: 11/20/2022] Open
Abstract
Background Cardiac tumors are rare, mostly benign with high embolic potential. Objectives To correlate the histological type of cardiac masses with their embolic potential,
implantation site and long term follow up in patients undergoing surgery. Methods Between January 1986 and December 2011, we retrospectively analyzed 185
consecutive patients who underwent excision of intracardiac mass (119 females,
mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72%
were asymptomatic and prior embolization was often observed (19.8%). The diagnosis
was established by echocardiography, magnetic resonance and histological
examination. Results Most tumors were located in the left side of the heart. Myxoma was the most common
(72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging
from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization,
stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a
predominance of malignant tumors (40% p < 0.0001). The histological type was a
predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event
(sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size,
atrial fibrillation, cavity and valve impairment were not associated with the
embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%)
and two recurrences 1 and 11 years after the operation, to the same cavity. Conclusion Most tumors were located in the left side of the heart. The histological type was
predictor of death and preoperative embolic event, while the implantation site
carries no relation with mortality or to embolic event.
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Affiliation(s)
- Ricardo Ribeiro Dias
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fábio Fernandes
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Félix José Alvarez Ramires
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Charles Mady
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Cícero Piva Albuquerque
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fábio Biscegli Jatene
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Lira EAG, Ramiro FS, Chiarelli FM, Dias RR, Feres M, Figueiredo LC, Faveri M. Reduction in prevalence of Archaea after periodontal therapy in subjects with generalized aggressive periodontitis. Aust Dent J 2014; 58:442-7. [PMID: 24320900 DOI: 10.1111/adj.12123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is evidence of a possible relationship between Archaea and periodontal disease; however, to date few studies have assessed the changes in prevalence of this domain after periodontal therapy. The aim of this randomized double-blind and placebo-controlled study was to assess if periodontal treatment with or without systemic antibiotic would change the prevalence of Archaea after periodontal therapy. METHODS Thirty subjects were randomly assigned to receive scaling and root planing (SRP) alone or combined with metronidazole (MTZ) + amoxicillin (AMX) for 14 days. Clinical and microbiological examinations were performed at baseline and at six months post-SRP. Nine subgingival plaque samples per subject were analysed for the presence of Archaea. RESULTS SRP alone or combined with MTZ + AMX significantly reduced the prevalence of subjects colonized by Archaea at six months post-therapy. However, no significant differences between treatment groups were observed (p > 0.05). Both therapies led to a statistically significant decrease in the mean percentage of sites colonized by Archaea (p < 0.05). A negative Spearman correlation was observed between the presence of Archaea and the mean clinical attachment gain at six months post-therapy (r(2) = -0.61; 95% CI -0.80- -0.31; p = 0.003). CONCLUSIONS SRP alone or combined with MTZ + AMX provides a similar reduction in the prevalence of Archaea in the subgingival biofilm of subjects with generalized aggressive periodontitis.
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Affiliation(s)
- E A G Lira
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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Borges LF, Blini JPF, Dias RR, Gutierrez PS. Why do aortas cleave or dilate? Clues from an electronic scanning microscopy study in human ascending aortas. J Vasc Res 2013; 51:50-7. [PMID: 24335355 DOI: 10.1159/000356296] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/26/2013] [Indexed: 11/19/2022] Open
Abstract
In ascending aorta aneurysms (AscAA) the whole vessel wall dilates, while in aortic dissections (AD) the wall cleaves into two sheets. Both may present fine elastic fragmentation and a decrease in collagen. We analyzed whether alterations in the three-dimensional structure of these fibers could be involved in the pathogenesis of AscAA/AD. Specimens obtained at surgery for these diseases (n = 4 for each) and on coronary artery bypass surgery (controls, n = 4) were submitted to treatments which either preserve collagen or the elastic structure. These samples were examined by scanning electron microscopy. In all groups most of the collagen fibers were packed, forming laminar structures very similar to the elastic lamellae. In AscAA/AD, the fibers showed signs of degradation and/or fragmentation. Elastic tissue was distributed in large sheets with fenestrations, with smaller branches between them. In 1 of the dissection cases and 2 of the aneurysm cases elastic sheet fragmentation, which under light microscopy seems to be located at random, had a pattern of clefts which were irregular but approximately transversal to the main axis of the wall. The recognition of this pattern and the degradation/fragmentation of collagen and elastic fibrils facilitates understanding of why the wall is weak and affected by aneurysms and dissections.
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Silvestre OM, Adam EL, Melo DTPD, Dias RR, Ramires FJA, Mady C. Anomalous right coronary artery arising from the pulmonary artery and constrictive pericarditis: an unusual association. Einstein (Sao Paulo) 2013; 11:367-9. [PMID: 24136766 PMCID: PMC4878598 DOI: 10.1590/s1679-45082013000300018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 05/02/2013] [Indexed: 11/21/2022] Open
Abstract
The association of anomalous right coronary artery originating from the pulmonary artery and constrictive pericarditis has never been showed in the literature. We present the first case of this unusual association in a patient with right heart failure. After diagnosis, the patient was referred to surgery and underwent phrenic-to-phrenic pericardiectomy; graft implant of right internal thoracic artery to right coronary artery; and ligation of the anomalous origin of the right coronary artery from the pulmonary artery. Such procedures solved the potential risk of sudden death related to anomalous right coronary artery originating from the pulmonary artery and alleviated the symptoms of heart failure caused by constrictive pericarditis.
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Dias RR, Mejia OAV, Fernandes F, Ramires FJA, Mady C, Stolf NAG, Jatene FB. Mortality impact of thoracic aortic disease in São Paulo state from 1998 to 2007. Arq Bras Cardiol 2013; 101:528-35. [PMID: 24100695 PMCID: PMC4106811 DOI: 10.5935/abc.20130203] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/11/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The epidemiological characteristics of thoracic aortic diseases (TAD) in the State of São Paulo and in Brazil, as well as their impact on the survival of these patients have yet to be analyzed. OBJECTIVES To evaluate the mortality impact of TAD and characterize it epidemiologically. METHODS Retrospective analysis of data from the public health system for the TAD registry codes of hospitalizations, procedures and deaths, from the International Code of Diseases (ICD-10), registered at the Ministry of Health of São Paulo State from January 1998 to December 2007. RESULTS They were 9.465 TAD deaths, 5.500 men (58.1%) and 3.965 women (41.9%); 6.721 dissections (71%) and 2.744. aneurysms. In 86.3% of cases the diagnosis was attained during autopsy. There were 6.109 hospitalizations, of which 67.9% were males; 21.2% of them died (69% men), with similar proportions of dissection and aneurysm between sexes, respectively 54% and 46%, but with different mortality. Men with TAD die more often than women (OR = 1.5). The age distribution for deaths and hospitalizations was similar with predominance in the 6th decade. They were 3.572 surgeries (58% of hospitalizations) with 20.3% mortality (patients kept in clinical treatment showed 22.6% mortality; p = 0.047). The number of hospitalizations, surgeries, deaths of in-patients and general deaths by TAD were progressively greater than the increase in population over time. CONCLUSIONS Specific actions for the early identification of these patients, as well as the viability of their care should be implemented to reduce the apparent progressive mortality from TAD seen among our population.
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Affiliation(s)
- Ricardo Ribeiro Dias
- Divisão de Cirurgia Cardiovascular do Instituto do Coração do Hospital
das Clínicas da Faculdade de Medicina da Universidade de São Paulo
- Mailling Address: Ricardo Ribeiro Dias, Avenida Dr. Enéas de Carvalho
Aguiar, 44, 2.º andar, sala 13. Postal Code: 05403-000, São Paulo, SP - Brazil.
E-mail:
| | - Omar Asdrubal Vilca Mejia
- Divisão de Cirurgia Cardiovascular do Instituto do Coração do Hospital
das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Fábio Fernandes
- Divisão de Cardiologia do Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Félix José Alvarez Ramires
- Divisão de Cardiologia do Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Charles Mady
- Divisão de Cardiologia do Instituto do Coração do Hospital das Clínicas
da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Noedir Antonio Groppo Stolf
- Divisão de Cirurgia Cardiovascular do Instituto do Coração do Hospital
das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Fabio Biscegli Jatene
- Divisão de Cirurgia Cardiovascular do Instituto do Coração do Hospital
das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Mejía OAV, Lisboa LAF, Puig LB, Dias RR, Dallan LA, Pomerantzeff PM, Stolf NAG. The 2000 Bernstein-Parsonnet score and EuroSCORE are similar in predicting mortality at the Heart Institute, USP. Braz J Cardiovasc Surg 2011; 26:1-6. [PMID: 21881704 DOI: 10.1590/s0102-76382011000100004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 12/20/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the performance of 2000 Bernstein-Parsonnet (2000BP) and additive EuroSCORE (ES) for predicting surgical mortality at the Heart Institute, University of São Paulo. METHODS A prospective observational design. Seven hundred and seventy four patients were operated for coronary artery bypass graft, valve or combined procedure between May and October, 2007, were analyzed. The mortality was estimated with the 2000BP and ES. The correlation between expected mortality and observed mortality was validated through calibration and discrimination test. RESULTS The patients were stratified into five groups for the 2000BP and three for the ES. The Hosmer-Lemeshow test for 2000BP (P = 0.70) and for ES (P = 0.39) indicate a good calibration. The ROC curve for the 2000BP = 0.84 and for the ES = 0.81 confirms that the models are good predictors (P<0.001). CONCLUSION Both models are similar and adequate in predicting surgical mortality at the InCor-USP.
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Affiliation(s)
- Omar Asdrúbal Vilca Mejía
- Cardiovascular Surgeon (Sciences Doctoral Student; Heart Institute; University of São Paulo School of Medicine Clinics Hospital (InCor-HCFMUSP.)
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Dias RR, Mejia OAV, Fiorelli AI, Pomerantzeff PMA, Dias AR, Mady C, Stolf NAG. Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction. Braz J Cardiovasc Surg 2011; 25:491-9. [PMID: 21340378 DOI: 10.1590/s0102-76382010000400012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 10/18/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement. METHODS From November 2002 to September 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations). Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88%) were followed for a mean period of 41.1 ± 20.8 months. RESULTS The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P <0.05). There was no difference neither in survival (95% CI = 86% - 96%, P= 0.1) nor in reoperation-free survival (95% CI = 85% - 90%, P = 0.29). The survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% CI = 70% - 95%, P = 0.001), (95% CI = 82% - 95% P = 0.03) and (95% CI = 81% - 95%, P = 0.03). Multivariate analysis showed that creatinine greater than 1.4 mg/dl, Cabrol operation and renal dialysis were predictors of mortality, respectively, with occurrence chance of 6 (95% CI = 1.8 - 19.5, P = 0.003), 12 (95% CI = 3 - 49.7, P = 0.0004) and 16 (95% CI = 3.6 - 71.3, P = 0.0002). CONCLUSIONS The aortic root reconstruction has a low early and late mortality, high survival free of complications and low need for reoperation. During the late follow-up, valve sparing aortic root reconstructions presented fewer incidences of bleeding, thromboembolic events and endocarditis.
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Fiorelli AI, Santos RHB, Oliveira JL, Lourenço-Filho DD, Dias RR, Oliveira AS, da Silva MFA, Ayoub FL, Bacal F, Souza GEC, Bocchi EA, Stolf NAG. Heart transplantation in 107 cases of Chagas' disease. Transplant Proc 2011; 43:220-4. [PMID: 21335192 DOI: 10.1016/j.transproceed.2010.12.046] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chagas' disease is endemic in South America. OBJECTIVE This research reviewed the experience with cardiac transplantation in Chagas' disease, emphasizing reactivation, immunosuppression, and mortality. METHODS Over 25 years from March 1985 to March 2010, 107/409 (26.2%) patients with Chagas' disease underwent heart transplantation, patients including 74 (71.1%) men and 72 (67.2%), in functional class IV with 33 (30.8%) on vasopressors and 17 (10.7%) on mechanical circulatory support. RESULTS The diagnosis of disease reactivation was performed by identifying the parasite in the myocardium (n = 23; 71.8%) in the subcutaneous tissue (n = 8; 25.0%), in blood (n = 11; 34.3%), or in central nervous tissue (n = 1; 3.1%). Hospital mortality was 17.7% (n = 19) due to infection (n = 6; 31.5%), graft dysfunction (n = 6; 31.5%), rejection (n = 4; 21.1%), or sudden death (n = 2; 10.5%). Late mortality was 27 (25.2%) cases, which were distributed as: rejection (n = 6; 22.2%), infection (n = 6; 22.2%), (n = lymphoma 4; 14.8%), sarcoma (n = 2; 7.4%), for constrictive pericarditis (n = 2; 7.4%) reactivation of Chagas' disease in the central nervous system (n = 1; 7.1%). CONCLUSIONS Transplantation in Chagas' disease has peculiar problems that differ from other etiologies due to the possibility of disease reactivation and the increased possibility of emergence of cancers. However, transplantation is the only treatment able to modify the natural progression of the disease in its terminal phase. Early diagnosis and rapid introduction of benzonidazole reverses the histological patterns. Immunosuppression, especially steroids, predisposes to the development of cancer and disease reactivation.
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Affiliation(s)
- A I Fiorelli
- Heart Institute of Sao Paulo University Medical School, Sao Paulo, Brazil.
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Conti DOD, Dias RR, Fiorelli AI, Stolf NAG. Ruptured thoracic aortic aneurysm in patient with systemic lupus erythematosus. Braz J Cardiovasc Surg 2011; 26:128-30. [DOI: 10.1590/s0102-76382011000100022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/02/2011] [Indexed: 05/26/2023] Open
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Dias RR, Mejia OV, Carvalho JR EV, Lage DOC, Dias AR, Pomerantzeff PMA, Mady C, Stolf NAG. Aortic root reconstruction through valve-sparing operation: critical analysis of 11 years of follow-up. Braz J Cardiovasc Surg 2010; 25:66-72. [DOI: 10.1590/s0102-76382010000100015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 02/14/2010] [Indexed: 11/22/2022] Open
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Santos LMD, Carmona MJC, Kim SM, Dias RR, Auler Jr JOC. Causas incomuns de instabilidade hemodinâmica durante revascularização miocárdica sem circulação extracorpórea. Braz J Anesthesiol 2010. [DOI: 10.1590/s0034-70942010000100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Santos LMD, Carmona MJC, Kim SM, Dias RR, Auler JOC. Uncommon causes of hemodynamic instability during myocardial revascularization without cardiopulmonary bypass. Rev Bras Anestesiol 2010; 60:84-89. [PMID: 20169267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 09/10/2009] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Myocardial revascularization (MR) in patients with ventricular hypertrophy and/or dysfunction is frequently performed without cardiopulmonary bypass (CB), since it can be difficult to wean those patients off CB. Intraoperative control demands strict hemodynamic adjustment, as well as partial clamping of the aorta to minimize hemodynamic changes. The objective of this study was to report two cases of hemodynamic instability during MR without CB after partial clamping of the aorta. CASE REPORT The first case is a female patient, whose aortic diameter was slightly reduced (2.8 cm); the second case refers to a patient with left ventricular ejection fraction (LVEF) of 24% on the echocardiogram. In both cases, significant hypotension and increase in pulmonary blood pressure were observed immediately after clamping of the aorta. The surgical teams were informed of the problem, and in both cases the hemodynamic instability was reverted after unclamping of the aorta. Afterwards, smaller areas of the aorta were clamped and proximal anastomoses were performed without intercurrence. CONCLUSIONS Although cardiac manipulation and changes in ventricular preload represent the most common causes of hemodynamic instability during MR without CB, in the cases presented here, hypotension and pulmonary hypertension were most likely secondary to a reduction in cardiac output due to the increase in afterload in patients with a relatively small aortic diameter or ventricular dysfunction even with partial clamping. Adequate intraoperative monitoring and immediate correction of the hemodynamic changes can minimize surgical morbidity and mortality.
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dos Santos LM, Carmona MJC, Kim SM, Dias RR, Auler JOC. Uncommon Causes of Hemodynamic Instability During Myocardial Revascularization without Cardiopulmonary Bypass. Braz J Anesthesiol 2010. [DOI: 10.1016/s0034-7094(10)70010-6] [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: 11/30/2022] Open
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Dias RR, Camurça FD, Leite Filho OA, Stolf NAG. Aneurisma do Seio de Valsalva direito causando compressão coronariana extrínseca. Arq Bras Cardiol 2009; 92:e47-50, e74-7. [PMID: 19629300 DOI: 10.1590/s0066-782x2009000600017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 06/23/2008] [Indexed: 11/21/2022] Open
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Fiorelli AI, Coelho GHB, Lima JL, Lourenço DDF, Gutierres P, Bacal F, Bocchi E, Dias RR, Stolf NAG. Massive degeneration and atrophy of the native heart after heterotopic transplantation: a case report. Transplant Proc 2009; 41:965-6. [PMID: 19376400 DOI: 10.1016/j.transproceed.2009.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Extreme myocardial degeneration leading to advanced stages of cardiomyopathy with extensive atrophy is rarely observed before patients die. However, heterotopic transplantation is a special situation wherein this phenomenon can be observed. The greater part of the failed heart shows recuperation after receiving circulatory assistance by reduction of myocardial work. Herein we have reported an unusual behavior of degenerative cardiomyopathy associated with intense myocardial apoptosis resulting in extreme ventricular atrophy after heterotopic heart transplantation. An 11-year-old girl with end-stage heart failure due to dilated cardiomyopathy of undetermined etiology without pulmonary hypertension underwent heterotopic cardiac transplantation with an undersized (by weight mismatch) donor heart. After 9 years heart failure reappeared due to native heart enlargement leading to allograft compression. The patient underwent native heart replacement leaving her with 2 donor hearts. Despite normal hemodynamic recuperation, the patient experienced massive arterial microemboli which led to death. Pathological studies showed exuberant myocardial degeneration in the native heart with intense atrophy of the muscle and gigantic ventricular enlargement. The left ventricle wall was extremely thin with rarefaction of cardiomyocytes and replacement by fibrosis. The right ventricle showed old extensive thrombosis. In conclusion, this report is not usual as it is not frequent to observe cardiomyopathy with an intense degree of myocardial degeneration and atrophy, because the patient dies earlier. In special situations it is possible that a recipient may have 2 donor hearts with normal hemodynamics. Heterotopic heart transplantation is a surgical alternative in a priority situation offering excellent outcomes; however, the native heart must be removed when there is compromise of the function of the heterotopic allograft.
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Affiliation(s)
- A I Fiorelli
- Heart Institute, São Paulo University School of Medicine, São Paulo, Brazil.
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Tiveron MG, Dias RR, Benvenuti LA, Stolf NAG. Thymic cyst as a differential diagnosis of acute thoracic aortic disease. Braz J Cardiovasc Surg 2009; 23:575-7. [PMID: 19229434 DOI: 10.1590/s0102-76382008000400021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 09/15/2008] [Indexed: 11/21/2022] Open
Abstract
Patient was referred to our Service with acute thoracic pain and diagnosis of intramural hematoma of the ascending aorta for surgical correction. The diagnostic investigation showed a cystic tumor involving the ascending aorta causing restriction of the right ventricular inflow. After resection, the histologic analysis disclosed the diagnosis of thymic cyst. The aim of this study is to describe a rare mediastinal tumor that may simulate a radiologic feature with characteristics of intramural hematoma and may result in a wrong therapeutic approach.
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Affiliation(s)
- Marcos Gradim Tiveron
- Disciplina de Cirurgia Cardiovascular, Heart Institute (InCor), University of São Paulo Medical School.
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Mady C, Fernandes F, Arteaga E, Ramires FJA, Buck PDC, Salemi VMC, Ianni BM, Nastari L, Dias RR. Níveis séricos de NT pro-BNP: relação com função sistólica e diastólica nas miocardiopatias e pericardiopatias. Arq Bras Cardiol 2008; 91:46-54. [DOI: 10.1590/s0066-782x2008001300008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Accepted: 12/10/2007] [Indexed: 11/22/2022] Open
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Dias RR, Silva IA, Fiorelli AI, Stolf NAG. New surgical strategy for acute type A aortic dissection: hybrid procedure. Braz J Cardiovasc Surg 2008; 22:495-7. [PMID: 18488119 DOI: 10.1590/s0102-76382007000400018] [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: 06/13/2007] [Accepted: 08/23/2007] [Indexed: 11/21/2022] Open
Abstract
The new surgical strategy to treat patients with acute type A aortic dissection, the hybrid procedure with an uncovered aortic stent, allows surgeons to treat the aortic arch and the proximal descending aorta, besides the ascending segment, without extension of cerebral or systemic ischemia.
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Dias RR, Judas G, Oliveira MAP, Malbouisson LMS, Fiorelli AI, Stolf NAG. Is the endovascular procedure an option for treatment of cronic type B aortic dissections? Braz J Cardiovasc Surg 2008; 22:441-7. [PMID: 18488111 DOI: 10.1590/s0102-76382007000400010] [Citation(s) in RCA: 2] [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: 03/20/2007] [Accepted: 10/17/2007] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Questions regarding the specific patient/disease that should be submitted to the endovascular procedure still remain unclear. The purpose of this report is to evaluate the endovascular treatment in chronic type B aortic dissections. METHODS Between 2003 and 2006, 11 patients with chronic type B aortic dissection were submitted to endovascular procedure through femoral artery. All of them were monitored with CT within 6 months, 1 year and afterwars anually. We prospectively evaluated false lumen patency and thoracic and abdominal aortic diameters in each time point. The data comparisons were made using Anova and chi-square tests with SPSS 13. RESULTS The endovascular stent-graft deployment was technically successful for all patients, with no hospital mortality. During the follow-up period the false lumen flows remained persistent in the thorax in 27.3% of the patients and in the abdomen in 81.8%. However, in all patients, in both segments, the aorta diameter was not significantly changed in size and shape. CONCLUSION Despite the small number of studied patients, the endovascular procedure for chronic type B aortic dissections does not appear to be an option for the treatment of these patients.
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Affiliation(s)
- Ricardo Ribeiro Dias
- General Cardiopaties Surgical Unit - Faculty of Medicine - University of São Paulo
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