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ABSTRACT: BACKGROUND: Assessment of the right ventricular (RV) function by echocardiography in patients with pulmonary thromboembolism (PTE) is complex and frequently qualitative. Tissue Doppler has been used for the semiquantitative assessment of this chamber, although with some limitations. OBJECTIVE: To evaluate RV function in PTE using tissue-Doppler echocardiography, in addition to atrial natriuretic peptide (BNP). METHODS: Patients with PTE were studied using tissue-Doppler echocardiography and BNP up to 24 hours after diagnosis; myocardial velocities (s'), strain, strain rate and RV myocardial performance index were obtained. RV dysfunction was diagnosed by chamber hypokinesia, abnormal septal motion and a RV/LV ratio >1. According to their BNP levels, the patients were divided into Group I, BNP < 50 pg/mL and Group II, BNP > 50 pg/mL. RESULTS: Of 118 patients, 100 (60 men, age = 55 ± 17 years) were analyzed; RV dysfunction was observed in 28%, more frequently in group II (19 vs. 9 patients, p < 0.001). Patients in group II were older (64 ± 19 vs. 50 ± 15 years), and had lower s' velocity (10.5 ± 3.5 vs. 13.2 ± 3.1 cm/s), and higher pulmonary pressure (48 ± 11 vs. 35 ± 11 mmHg), p < 0.001. The cut-off point of s' for RV dysfunction was 10.8 cm/s (specificity = 85%, sensitivity = 54%), with moderate correlation between BNP and s' wave (r = -0.39). CONCLUSION: In PTE, RV dysfunction on echocardiography is accompanied by BNP elevation; although tissue-Doppler imaging adequately confirms the presence of RV dysfunction, it has a limited sensitivity for this diagnosis.
Arquivos brasileiros de cardiologia 05/2013; · 1.32 Impact Factor
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International journal of cardiology 11/2012; · 7.08 Impact Factor
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ABSTRACT: INTRODUCTION: The most common indication for surgical correction of giant left atrium is associated with mitral valve insufficiency with or without atrial fibrillation. Several techniques for this purpose are already described with varying results. OBJECTIVE: To present the initial experience with the tangential triangular resection technique (Pomerantzeff). METHODS: From 2002 to 2010, four patients underwent mitral valve operation with reduction of left atrial volume by the technique of triangular resection tangential in our service. Three patients were female. The age ranged from 21 to 51 years old. The four patients presented with atrial fibrillation. Ejection fraction of left ventricle preoperatively ranged from 38% to 62%. The left atrial diameter ranged from 78mm to 140mm. After treatment of mitral dysfunction, the left atrium was reduced by resecting triangular tangential posterior wall between the pulmonary veins to avoid anatomic distortion of the mitral valve or pulmonary veins, reducing tension in the suture line. RESULTS: Average hospital stay was 21.5 ± 6.5 days. The mean cardiopulmonary bypass time was 130 ± 30 minutes. There was no surgical bleeding or mortality in the postoperative period. All patients had sinus rhythm restored in the output of cardiopulmonary bypass, maintaining this rate postoperatively. The average diameter of the left atrium was reduced by 50.5% ± 19.5%. The left ventricular ejection fraction improved in all patients. CONCLUSION: Initial results with this technique have shown effective reduction of the left atrium.
Brazilian Journal of Cardiovascular Surgery 06/2012; 27(2):290-295.
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ABSTRACT: The natriuretic peptides, brain natriuretic peptide (BNP) and its N-terminal prohormone (NT-proBNP), can be used as diagnostic and prognostic markers for aortic stenosis (AS). However, the association between BNP, NT-proBNP, and long-term clinical outcomes in patients with severe AS remains uncertain.
A total of 64 patients with severe AS was prospectively enrolled into the study, and underwent clinical and echocardiographic assessments at baseline. Blood samples were drawn for plasma BNP and NT-proBNP analyses. The primary outcome was death from any cause, through a six-year follow up period. Cox proportional hazards modeling was used to examine the association between natriuretic peptides and long-term mortality, adjusting for important clinical factors.
During a mean period of 1,520 +/- 681 days, 51 patients (80%) were submitted to aortic valve replacement, and 13 patients (20%) were medically managed without surgical interventions. Mortality rates were 13.7% in the surgical group and 62% in the medically managed group (p < 0.001). Patients with higher plasma BNP (> 135 pg/ml) and NT-proBNP (> 1,150 pg/ml) levels at baseline had a greater risk of long-term mortality (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.1-9.1; HR 4.3, 95% CI 1.4-13.5, respectively). After adjusting for important covariates, both BNP and NT-proBNP remained independently associated with long-term mortality (HR 2.9, 95% CI 1.5-5.7; HR 1.8, 95% CI 1.1-3.1, respectively).
In patients with severe AS, plasma BNP and NT-proBNP levels were associated with long-term mortality. The use of these biomarkers to guide treatment might represent an interesting approach that deserves further evaluation.
The Journal of heart valve disease 05/2012; 21(3):331-6. · 0.81 Impact Factor
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Arquivos brasileiros de cardiologia 08/2011; 97(2):e39. · 1.32 Impact Factor
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ABSTRACT: Cardiac resynchronization therapy consists of a promising treatment for patients with severe heart failure, but about 30% of patients do not exhibit clinical improvement with this procedure. However, approximately 10% of patients undergoing this therapy may have hyperresponsiveness, and three-dimensional echocardiography can provide an interesting option for the selection and evaluation of such patients.
Arquivos brasileiros de cardiologia 06/2011; 96(6):e119-22. · 1.32 Impact Factor
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ABSTRACT: Endomyocardial biopsy (EMB) is the gold standard method for the diagnosis of cellular rejection (CR) after heart transplantation (HT).
To test the hypothesis that tissue Doppler imaging (TDI) could detect CR > 3A and add diagnostic information compared to conventional Doppler.
Fifty-four HT patients underwent 129 EMB and a TDI echocardiographic study within 24 hours. We compared HT patients with CR > 3A versus HT patients with CR < 3A, with a normal matched control group (13 patients). We measured TDI systolic (S), early diastolic (e'), late diastolic (a') velocities and e'/a' ratio in the left ventricular annulus, basal and medium (mid) segments of the septal (SEP), lateral (LAT), inferior (INF), anterior (ANT) walls; and in the right ventricular annulus.
HT patients showed CR > 3A in 39/129 (30.2%) EMB. The best isolated predictor for CR diagnosis was a'LAT, with a sensitivity of 76.3%, specificity of 73.8% (p = 0.001). In the multivariate analysis, a'LAT (p = 0.001), a'SEP (p = 0.002), e'/a' LAT ratio (p = 0.006), e'Mitral/ e'LAT ratio (p = 0.014), SINF (p = 0.009) predicted CR > 3A. We obtained a score with a sensitivity of 88.2%, accuracy of 79.6% and negative predictive value of 92.9% to diagnose CR > 3A. Conventional Doppler (mitral and pulmonary venous flow) was not relevant to predict CR > 3A.
TDI added diagnostic information to predict CR > 3A compared to conventional Doppler. A TDI-based model could become a potential method to detect CR > 3A after heart transplantation.
Arquivos brasileiros de cardiologia 05/2011; 97(1):8-16. · 1.32 Impact Factor
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Danielle Menosi Gualandro,
Pai Ching Yu,
Daniela Calderaro,
André C Marques,
Claudio Pinho,
Bruno Caramelli,
Alina Coutinho Rodrigues Feitosa,
Beatriz Ayub,
Carisi A Polanczyk,
Carlos Jardim, [......],
Milena Macatrão,
Paula Ribeiro Villaça,
Pedro Silvio Farsky,
Renato Delascio Lopes,
Renato Scotti Bagnatori,
Roberto Henrique Heinisch,
Sandra F Menosi Gualandro,
Tarso Augusto Duenhas Accorsi,
Walkiria Samuel Avila,
Wilson Mathias
Arquivos brasileiros de cardiologia 01/2011; 96(3 Suppl 1):1-68. · 1.32 Impact Factor
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ABSTRACT: Mitral valve repair is the treatment of choice to correct mitral insufficiency. Although the literature related to left atrial and ventricular behavior after mitral repair without use of prosthetic rings is scarce.
To analyze cardiac morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.
Were included 14 patients with mixomatous mitral valve insufficiency that were submitted to mitral valve repair with the Double Teflon technique. Of them, 13 patients were in class III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistic analysis was made by repeated measures ANOVA test and was considered statistically significant P <0.05.
The analysis of systolic volumes, atrial and ventricular, demonstrated a significant volumetric reduction between immediate postoperative period and 1 year (P = 0.028 and P = 0.020, respectively). Between preoperative period and 1 year, there was a mean reduction in atrial and ventricle volumes of 19.9% and 15.4%, respectively. Atrial and ventricle diastolic volumes presented a significant reduction in immediate postoperative period (P <0.001 and P = 0.024, respectively), remaining stable during the study. There was an increase in left atrial ejection fraction after 6 months (P <0.001), although there was no significant variation in left ventricle ejection fraction.
Patients submitted to mitral valve repair by the Double Teflon technique demonstrated a left atrial and ventricle reverse remodeling. These reductions were associated with an improvement in left atrial function during the study.
Brazilian Journal of Cardiovascular Surgery 12/2010; 25(4):534-42.
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ABSTRACT: The use of echocardiography in the intensive care unit for patients in shock allows the accurate measurement of several hemodynamic variables in a noninvasive way. By using echocardiography as a hemodynamic monitoring tool, the clinician can evaluate several aspects of shock states, such as cardiac output and fluid responsiveness, myocardial contractility, intracavitary pressures, and biventricular interactions. However, to date, there have been few guidelines suggesting an objective hemodynamic-based examination in the intensive care unit, and most intensivists are usually not familiar with this tool. In this review, we describe some of the most important hemodynamic parameters that can be obtained at the bedside with transthoracic echocardiography.
Shock (Augusta, Ga.) 09/2010; 34 Suppl 1:59-62. · 2.87 Impact Factor
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ABSTRACT: The right anterolateral thoracotomy is an alternative technique for surgical approach of mitral valve. In these cases, femoral-femoral bypass still has been used, rising occurrence of complications related to femoral cannulation. Objective: Describe the technique and results of mitral valve treatment by right anterolateral thoracotomy using aortic cannulation for cardiac pulmonary bypass (CPB).
From 1983 e 2008, 100 consecutive female patients, with average age 35 ±13 years, 96 (96%) underwent mitral valve surgical treatment in the Heart Institute of São Paulo. A right anterolateral thoracotomy approach associated with aortic cannulation was used for CPB. Eighty (80%) patients had rheumatic disease and 84 (84%) patients presented functional class III or IV.
Were performed 45 (45%) comissurotomies, 38 (38%) valve repairs, 7(7%) mitral valve replacements, seven (7%) recomissurotomies and three (3%) prosthesis replacement. Sparing surgery was performed in 90 (90%) patients. The average CPB and clamp time were 57 ± 27 min e 39 ± 19 min, respectively. There were no in-hospital death, reoperation due to bleeding and convertion to sternotomy. Introperative complications were related to heart harvest (5%), especially in reoperations (3%). The most important complications in postoperative period were related to pulmonary system (11%), followed by atrial fibrilation (10%) but without major systemic repercussions. The mean inhospital length of stay was 8 ± 3 days. Follow-up was 6.038 patients/month. Actuarial survival was 98.0 ± 1.9% and freedom from reoperation was 81.4 ± 7.8% in 180 months.
The right anterolateral thoracotomy associated with aortic cannulation in mitral valve surgery is a simple technique, reproducible and safety.
Brazilian Journal of Cardiovascular Surgery 09/2010; 25(3):322-5.
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Marcelo Luiz Campos Vieira,
Wercules Antônio Oliveira,
Alexandre Ferreira Cury,
Cordovil Adriana,
Ana Clara Tude Rodrigues,
Gustavo Alberto Frazatto Naccarato,
Claudia Gianini Monaco,
Lea Paula Ravani Beneti Costa,
Renata Barbara Romano,
João Roberto Calatroia,
Tania Regina Afonso,
Glaucia Maria Penha Tavares,
Laise Antônia Bonfim Guimarães,
Edgar Bezerra Lira Filho,
Marco Antonio Perin,
Claudio Henrique Fischer,
Samira Saady Morhy
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ABSTRACT: Objective: The prognosis of patients with acute myocardial infarction depends on multiple features that can demonstrate myocardial injury degree (such as serum markers of cardiac necrosis), and also on adaptive mechanisms relative to the acute event. The aim of the study was to assess the relation between biochemical and echocardiographic findings from three-dimensional echocardiographic (3D Echo) analysis and echocardiographic two-dimensional (2D Echo) left ventricular ejection fraction in patients with ST-segment elevation acute myocardial infarction , submitted to primary percutaneous treatment. Methods: A prospective study with 2D Echo and 3D Echo of 23 patients (17 males, mean age of 57 ± 13 years) with ST-segment elevation acute myocardial infarction, primarily percutaneously treated (stent). Serum cardiac markers (creatine kinase MB, Troponin I and Myoglobin) and serum brain natriuretic peptide were compared to echocardiographic parameters (volumes, left ventricular ejection fraction and ventricular dyssynchrony index). The statistical analysis was performed using Pearson’s correlation coefficient, 95% CI, p < 0.05, linear regression equation and Bland & Altman test. Results: Pearson’s correlation coefficient (r)relative to 3D left ventricular ejection fraction: 1- brain natriuretic peptide: r: - 0.7427, p < 0.0001; 2- creatine kinase MB: r: - 0.660, p = 0.001. Left ventricular ejection fraction 2D (r) : 1- brainnatriuretic peptide: r: - 0.5478, p = 0.001; 2- creatine kinase MB: r: - 0.4800, p < 0.0277. Other associations were not significant. Conclusions: In this series, it was observed better correlation in regard to serum creatine kinase MB , brain natriuretic peptide and 3D Echo left ventricular ejection fraction, when compared to 2D Echo left ventricular ejection fraction.
Einstein. 01/2010;
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Alexandre Ferreira Cury, Marcelo Luiz Campos Vieira,
Claudio Henrique Fischer,
Ana Clara Tude Rodrigues,
Adriana Cordovil,
Claudia Monaco,
Gustavo Alberto Naccarato,
Glaucia Tavares,
Edgar Bezerra Lira Filho,
Laise Antonia Guimarães,
Samira Saady Morhy
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ABSTRACT: TEE is a semi-invasive tool broadly used and its utilization associated to sedatives drugs might to affect the procedure safety.
to analyze aspects of TEE safety associated to the use of Midazolan (MZ) and Flumazenil (FL) and the influence of the clinical variables on the event rate.
prospective study with 137 patients that underwent TEE with MZ associated to moderate sedation. We analyzed the following events: complications related with the topical anesthesia, with MZ use and with the procedure. Uni- and multivariate analyses were used to test the influence of the clinical variables: age, sex, stroke, myocardiopathy (MP), duration of the test, mitral regurgitation (MR) and the MZ dose.
All patients (65+/-16 yrs; 58% males) finished the examination. The mean doses of MZ and FL were 4.3+/-1.9 mg and 0.28+/-0.2 mg, respectively. The duration of the examination and the mean ejection fraction (EF) were 16.4+/-6.1 minutes and 60+/-9%, respectively. Mild hypoxia (SO2<90%) was the most common event (11 patients); 3 patients (2%) presented transient hypoxia due to upper airway obstruction by probe introduction and 8 (5.8%) due to hypoxia caused by MZ use. Transient hypotension (SAP<90mmHg) occurred in 1 patient (0.7%). The multivariate analysis showed that severe MR, MP (EF<45%) and high doses of MZ (>5mg) were associated with events (p<0.001). The EF was 40%, in the group with MP and 44% in the group with severe MR and it can be a factor associated with clinical events in the last group.
TEE with sedation presents a low rate of events. There were no severe events and there was no need to interrupt the examinations.
Arquivos brasileiros de cardiologia 11/2009; 93(5):478-83. · 1.32 Impact Factor
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ABSTRACT: The effect of dobutamine on carotid and brachial arteries compliance and the association of L-arginine as a potential nitric oxide pathway restorer were evaluated in patients with heart failure. Twenty-seven outpatients participated. Drugs used for the treatment of heart failure were withheld at least 24 hours before the study. The carotid and brachial artery diameters and hemodynamic variables were evaluated by ultrasonography and Doppler in baseline conditions, with dobutamine, with flow-mediated dilatation (FMD), and with placebo or L-arginine alone and associated with dobutamine. There was a significant increase in carotid peak blood flow with dobutamine when compared with that at baseline (P = 0.0001) or with L-arginine or placebo (P = 0.0001 and P = 0.0001, respectively), with increase of the cardiac index (P = 0.0001). Dobutamine did not increase carotid arterial compliance. FMD significantly increased the brachial peak blood flow (P = 0.0022) and the artery diameter (P = 0.0001). Dobutamine did not change the brachial artery diameter. Brachial peak blood flow was increased with dobutamine alone or associated with placebo or L-arginine comparing with L-arginine or placebo alone (P = 0.0168 and P = 0.0140, respectively), but was not increased compared with that at baseline. L-arginine infusion was not associated with changes in carotid, brachial, or in the cardiac index. We concluded that dobutamine increased carotid peak blood flow in patients with heart failure, although without changing the arterial compliance. The FMD of brachial artery was maintained, while brachial artery response to dobutamine infusion was less reliable. The carotid artery may be under the direct influence of the heart, while the brachial artery may be under predominant local control.
Echocardiography 09/2009; 26(8):934-42. · 1.24 Impact Factor
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Arquivos brasileiros de cardiologia 09/2009; 93(3):e57. · 1.32 Impact Factor
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ABSTRACT: Thoracic aortic dissection is a disease of great mortality in its initial phase, but in some cases it can assume chronic course. We report a case of a patient with Stanford type A1 aortic dissection, admitted with mental confusion, dyspnea and event of severe hemoptysis. Electrocardiogram showed unspecific change and chest X-ray revealed opacification of the left hemithorax. Transthoracic echocardiogram did not show aortic dissection, but showed image similar to hemithorax leading to the suspicion of aortic rupture. The patient developed cardiovascular collapse and evolved to death. This case describes two unusual presentations of aortic dissection: hemothorax and severe hemoptysis.
Brazilian Journal of Cardiovascular Surgery 06/2009; 24(2):245-8.
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ABSTRACT: Real-time three-dimensional echocardiography (RT-3D-Echo) and ultrafast computed tomography (CT) are two novel methods for the analysis of LV ejection fraction and volumes.
To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT.
Thirty nine consecutive patients (27 men, mean age of 57+/-12 years) were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. Statistical analysis: coefficient of correlation (r: Pearson), Bland-Altman analysis, linear regression analysis, 95% CI, p<0.05.
RT-3D-Echo measurements: LVEF ranged from 56.1 to 78.6 (65.5+/-5.58)%; end-diastolic volume ranged from 49.6 to 178.2 (87+/-27.8) ml; end-systolic volume ranged from 11.4 to 78 (33.1+/-13.6) ml. CT scan measurements: LVEF ranged from 53 to 86% (67.8+/-7.78); end-diastolic volume ranged from 51 to 186 (106.5+/-30.3) ml; end-systolic volume ranged from 7 to 72 (35.5+/-13.4)ml. Correlations between RT-3D-Echo and CT were: LVEF (r: 0.7888, p<0.0001, 95% CI 0.6301 to 0.8843); end-diastolic volume (r: 0.7695, p<0.0001, 95% CI 0.5995 to 0.8730); end-systolic volume (r: 0.8119, p<0.0001, 95% CI 0.6673 to 0.8975).
Good correlation between LVEF and ventricular volume parameters as measured by RT-3D-Echo and 64-slice ultrafast CT was found in the present case series.
Arquivos brasileiros de cardiologia 04/2009; 92(4):294-301. · 1.32 Impact Factor
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ABSTRACT: Neurohormones are involved in the physiopathology of heart failure, but little is known about its behavior in significant chronic aortic regurgitation (AR). We aimed at analyzing the behavior of these mediators in AF.
We aimed at analyzing the behavior of these mediators in AF.
We analyzed 89 patients with AF, whose mean age was 33.6+/-11.5 years and of whom 84.6% were males, 60% asymptomatic, all with rheumatic etiology. After the clinical and echocardiographic assessment, plasma measurements of tumor necrosis factor (TNF), soluble TNF receptor types I and II (sTNFRI e sTNFRII), interleukin-6 (IL-6), its soluble receptor (sIL6R), endothelin-1 and B-type natriuretic peptide (BNP) were carried out; 12 healthy individuals were used as controls.
The mean values of the left ventricle diastolic diameter (LVDD) were 71.9+/-8.3mm, whereas the mean values of the LV systolic diameter (LVSD) were 50.4+/-9.3mm. The neurohormonal levels were elevated in patients with AF (TNF 92.65+/-110.24 pg/mL vs. 1.67+/-1.21 pg/ml in controls, p<0.001), (IL-6 7.17+/-7.78 pg/ml vs. 0.81+/-0.38 pg/mL in controls, p=0.0001) and TNFRI (894.75+/-348.87 pg/mL vs. 521.42+/-395.13 pg/ml, p=0.007). Except for the BNP levels, symptomatic and asymptomatic patients presented a similar neurohormonal profile. There was a correlation between TNFRII and LVDD (r=-0.329, p=0.038) and LVSD (r=-0.352, p=0.027). BNP levels were significantly higher in symptomatic patients and only in the latter it was possible to establish a correlation between BNP and ventricular diameters.
Patients with significant chronic AF present high neurohormonal levels, with no correlation with the symptomatic status. The TNFRII and BNP levels could be correlated with ventricular diameters, but only the latter could be correlated with symptoms.
Arquivos brasileiros de cardiologia 03/2009; 92(2):143-56. · 1.32 Impact Factor
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Arquivos brasileiros de cardiologia 09/2008; 91(2):e28. · 1.32 Impact Factor
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Marcelo Luiz Campos Vieira,
Alexandre Ferreira Cury,
Gustavo Alberto Frazatto Naccarato,
Wercules Antonio Alves de Oliveira,
Cordovil Adriana,
Ana Clara Tude Rodrigues,
Claudia Gianini Monaco,
Edgar Bezerra Lira Filho,
Glaucia Maria Penha Tavares,
Pfeferman Abraham,
Marcia Regina Pinho Makdisse,
Claudio Henrique Fischer,
Samira Saady Morhy
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ABSTRACT: Objective: To compare the three-dimensional echocardiographic analysisof left ventricular (LV) synchrony to LV ejection fraction (LVEF) as measuredby two-dimensional (2D) and three-dimensional (3D) echocardiography(ECHO). Methods: This is a prospective study of 71 patients (41 males,aged 49 ± 11 years), 40 of whom with normal cardiac anatomy (ECHO) andelectrocardiography (ECG) (Group N), and 31 with dilated cardiomyopathy(Group DCM). LVEF, volumes and 16-segment dyssynchrony index % (DI)were measured using 3D-ECHO. LVEF (Simpson’s rule) and volumes weremeasured using 2D-ECHO. Data were compared using Pearson correlationcoefficient (r), 95% CI, linear regression equation and Bland-Altman analysis,p < 0.05. Results: DI% ranged from 0.32 to 21.7% (5.94 ± 6.46), 3D LVEFfrom 0.16 to 0.73 (0.51 ± 0.15); and 2D LVEF from 0.2 to 0.7 (0.47 ± 0.17).The correlation coefficient (r) for DI and 3D LVEF was (r): -0.8203, p <0.0001, CI = -0.8844 to -0.7259, linear regression for DI% (x) and 3D LVEF(y) was y = 63.4515 + (-2.0233) x, p < 0.0001. The correlation coefficient(r) for DI% and 2D LVEF was (r): -0.7046, p < 0.0001, CI = -0.7675 to-0.5824, linear regression for DI% (x) and 2D EF (y) was y = 59.345 +(-3.8721) x, p < 0.0001. Conclusions: Good negative correlation betweenLV synchrony (3D-ECHO) and echocardiographic LVEF (2D and 3D) wasobserved in this series.
Einstein. 01/2008;
