Valdano Manuel

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Verified

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• MD PhD
• Professor (Associate) at Clínica Girassol

Cardiothoracic ratio upper to 0.60 is a fact of poor prognostic in patients with Ebstein’s anomaly and the prognostic is worse if is associated with others congenital heart disease. We present 4-months black boy with Ebstein’s anomaly associated with atrial septal defect, pulmonary valve atresia and patent ductus arteriosus wherein the cardiothorac...

Introduction Rheumatic heart disease remains a public health problem, especially in developing countries. The mitral valve (MV) is the main affected cardiac structure, requiring intervention in many cases. The discussion of which is the best option - repair or replacement - is still a controversy. Objective To compare the survival of patients with...

Background: Several clinical trials have demonstrated non-inferiority of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) and low to intermediate surgical risk. However, mid-term results are still contentious. Question: Is TAVR superior to SAVR in the m...

Background: Dual antiplatelet therapy (DAPT) is well established as standard of care following percutaneous coronary intervention (PCI). Recent trials have shown a potential benefit in the reduction of hemorrhagic events with a shorter course of DAPT. However, the optimal duration of DAPT following PCI remains unclear. Question: Is 1 month of DAPT...

Background The neutrophil-lymphocyte ratio (NLR) is an easily accessible and inexpensive biomarker that has been shown to predict morbidity and mortality in congenital cardiac surgery. However, its regulatory mechanism remains unclear. This study aims to compare and correlate the tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, and I...

Submitral aneurysm is a rare type of non-ischaemic ventricular aneurysm. We describe the case of a 26-year-old woman with progressive dyspnoea for approximately 1 year who was diagnosed with a ruptured submitral aneurysm in the left atrium with severe regurgitation. The patient underwent aneurysm correction and mitral valve repair, and post-operati...

Acute ascending aortic dissection is an uncommon disease that causes tragic loss of life if not treated as an emergency. An 82-year-old female, with a history of arterial hypertension, dyslipidemia and chronic venous insufficiency, was admitted to the emergency department (ED) of the Luanda Medical Center complaining of excruciating chest pain radi...

O Aneurisma do seio de valsava (ASV) e o pseudoaneurisma na região do corpo fibroso entre as válvulas mitral e aórtica (tambem conhecida como fibrosa intervalvar mitro-aórtica), são patologias cardíacas raras, ocorrendo em separado, em menos de 1% dos doentes submetidos a cirurgia cardíaca, na sua maioria em homens. Os ASV congénitos podem estar as...

Introdução: A ventilação mecânica não-invasiva (VMNI) tem sido empregada como recurso para a reversão do quadro de insuficiência respiratória em diversas situações. Esse tipo de suporte ventilatório se dá pelo uso da pressão positiva, aumentando a ventilação alveolar. A VMNI é definida como um suporte ventilatório de pressão positiva realizado sem...

A endocardite fúngica é uma doença rara, com alta mortalidade apesar do tratamento médico e cirúrgico combinados. São factores de risco a cirurgia valvular e antibioterapia prévias, toxicodependência, catéteres intravasculares e estado de imunossupressão. As espécies de Candida são os agentes etiológicos mais frequentes. Apresentamos o caso de um d...

Abstract: We report the case of a 82-year-old woman, known to have hypertension, who was admitted to the emergency department of Luanda Medical Center for chest pain 24 hours after an episode of commercial aircraft depressurization and whose thoraco-abdominal CT revealed a Stanford type A acute aortic dissection. Key clinical message: Elderly patie...

Background: Most patients who undergo tetralogy of Fallot (TOF) repair experience late right ventricle (RV) dysfunction due to pulmonary valve regurgitation (PVR). Cardiac magnetic resonance (CMR) is the gold standard method for evaluating RV during follow-up. Global longitudinal strain (GLS) has been introduced as a novel method for the assessmen...

Here we present a case of a 22-year-old man with a 6-year history of non-specific chest pain and fatigue. Echocardiography and computed tomography showed multiple hydatid cysts involving entire left ventricular myocardium, a decreased ejection fraction, and no involvement of other organs. Surgical resection was contraindicated because of the severi...

We present a case of a patient admitted with acute pulmonary edema. An echocardiogram showed a giant myxoma of the left atrium causing mitral valve obstruction. The patient underwent urgent cardiac surgery for tumor resection. There were no postoperative complications, and the follow‐up was uneventful. This case highlights that left atrium polypoid...

Operative mortality after repair of congenital heart disease has improved dramatically over the past few decades. Nevertheless, there is always room for the additional mitigation of complications and mortality. Being able to anticipate adverse outcomes is clearly important, especially when using low-cost and easily accessible resources. The neutrop...

Background: Coronary artery disease is a major public health concern worldwide. In Africa, varying rates of progression increased in different countries. In Angola, although the epidemiological scenario is dominated by infectious diseases, the prevalence of coronary artery disease is increasing with notable impacts, requiring the creation of mechan...

Introduction: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries...

We report the images of an octogenarian female patient admitted to the hospital with complaints of dyspnea, melena, and ascites in which the diagnosis of hepatocellular carcinoma with tumoral thrombi invasion of the portal vein, the hepatic veins, the inferior vena cava, and the right atrium was made. Regarding the case, the authors make a brie...

Introduction: Elevated neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcomes in cyanotic patients undergoing single ventricle palliation. Little is known about this biomarker on patients with tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease. Our objective is to study the impact of preoperative NLR o...

Since the beginning of the teaching process in modern medical schools, the evolution of medicine brought up the need for medical education to also evolve. We passed through the ages of the theatres where surgeries and lectures were performed, and the teachers were the main source of knowledge until today with technology , simulation-learning and ev...

Introduction: Acute kidney injury is a risk factor for chronic kidney disease and mortality after congenital heart surgery under cardiopulmonary bypass. The neutrophil-lymphocyte ratio is an inexpensive and easy to measure biomarker for predicting outcomes in children with congenital heart disease undergoing surgical correction. Objective: To ident...

The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the go...

Background Anomalous aortic origin of coronary artery is a rare finding, with varied presentation and symptomatology. Increasingly recognized by cardiac imaging, when found it raises questions about the appropriate approach and management. Case presentation We present a case of an 11‐year‐old female who presented with episodes of shortness of brea...

In December 2019, the novel coronavirus disease 2019 (COVID-19) emerged in China and spread rapidly around the world, resulting in a pandemic declared by the World Health Organization in March 2020. The disease has affected more than 11 million people in Brazil, with more than 265.000 deaths to date, as we are now facing a second wave of infections...

During the COVID-19 pandemic, many specialists doctors found themselves in a situation that they had not faced for a long time: treating patients out of their subarea of expertise. The possibilities of teaching and learning through the modalities of webinars brought to these days the urgent necessity for teamwork and interdisciplinary approach, tak...

Pulmonary artery stenosis is a frequent complication after arterial switch operation. This case study presented a complex pulmonary artery stenosis initially treated with bilateral pulmonary artery stenting. The patient was found to have aortic valve endocarditis and recurrent pulmonary artery stenosis. The aortic valve was replaced and the pulmona...

Introduction: Elevated neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcomes in children undergoing congenital heart surgery under cardiopulmonary bypass (CPB). Objective: To compare preoperative NLR levels between cyanotic and acyanotic children undergoing surgical repair with CPB. Methods: We performed a retrospective co...

During COVID-19 pandemic, heart transplantation centers are prioritizing patients at higher short-term mortality risk and offering durable left ventricular assist device for patients who meet indication criteria. Unfortunately, this is not feasible for all heart transplantation centers worldwide. We report 4 cases of early postoperative heart trans...

Introduction: Anemia and blood transfusion are risk factors for morbidity/mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The objective of this study is to analyze the association of blood transfusion with morbidity/ mortality in patients undergoing coronary artery bypass grafting (CABG) under CPB in the state o...

Introduction: Subaortic and submitral aneurysms have been collectively referred as subvalvular aneurysms (SVA), which arerelatively rare cardiac malformation commonly, reported in young adult African ancestry. Methods: Herein is provided a comprehensive review of all relevant English-language articles published from 1962 to December 2018, regarding...

Predictive value of pre-operative neutrophil–lymphocyte ratio for children undergoing congenital heart surgery - Valdano Manuel, Leonardo A. Miana, Marcelo B. Jatene

Objectives: Atrioventricular valve (AVV) regurgitation in patients with single ventricle (SV) physiology severely impacts prognosis; the appropriate timing for surgical treatment is unknown. We sought to study the results of surgical treatment of AVV regurgitation in SV patients and evaluate risk factors for mortality. Methods: Medical records of 8...

Introduction: The neutrophil-lymphocyte ratio (NLR) has been associated with worse outcomes in patients undergoing coronary artery bypass graft surgery. Little is known about this association in the pediatric population who require surgery for congenital heart defects, especially in patients with a single ventricle (SV). Objective: To analyze th...

An isolated mitral valve cleft is a relatively rare anomaly. We report the usefulness of real time three-dimensional transthoracic echocardiography in the assessment of isolated cleft of the anterior mitral leaflet in an 11-year-old asymptomatic female child.

A The coronary artery bypass graft (CABG) is common. Sometimes can be challenging. Here we present a 79‐year‐old man presented with unstable angina and simultaneous activelower gastrointestinal bleeding (hemoglobin level, 5.1 g/L) due to actinic rectitis after radiation therapy for prostate carcinoma performed 1 year previously. Coronary angiograph...

Either the pseudoaneurysm of mitral-aortic intervalvular fibrosa or the aneurysms of Valsalva are rare cardiac conditions. Con-comitant diagnosis in the same patient is extremely rare with only one case report. Herein, we described an extremely rare case of concomitant pseudoaneurysm of mitral-aortic intervalvular fibrosa and aneurysm of left sinus...

Introduction:: Single ventricle physiology management is challenging, especially in low-income countries. Objective:: To report the palliation outcomes of single ventricle patients in a developing African country. Methods:: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between Ma...

Patient: Male, 51 Final Diagnosis: Liver cirrhosis by hepatitis virus C and hepatocellular carcinoma Symptoms: Ascites Medication: — Clinical Procedure: Liver transplantantion Specialty: Surgery Objective Rare co-existance of disease or pathology Background Adequate portal venous flow is required for successful liver transplantation. Reduced veno...

We describe a case of a 65-year-old patient who developed a rare fatal complication of a previously asymptomatic descending aortic aneurysm over a two-week period. The authors emphasize the importance of complying with guidelines for the diagnosis and management of patients with thoracic aortic disease. Keywords: Aneurysm, Descending aorta, Comput...

We report a 60-year-old female who underwent resection of an endometrial stromal sarcoma of the right ventricle 17 years following a hysterectomy and radiation therapy for the same tumor.

Background Epidemiological patterns of cardiac disease differ between developed countries and African nations. Despite the collaborative efforts of developed countries, several obstacles hinder the implementation of successful programmes for the management of children with heart disease in Africa. Materials and methods This study is a retrospectiv...

Background: Multimodality imaging has been used in diagnosis of submitral aneurysm, including the use of magnetic resonance imaging. Objective: This study sought to investigate whether magnetic resonance imaging can be useful in the diagnosis of submitral aneurysm. Methods: A systematic literature review in PubMed, LILACS and Google Scholar limited...

Background The burden of cardiovascular diseases (CVD) is increasing in most countries of sub-Saharan Africa. However, as there is a scarcity of data, little is known about CVD in Angola. This study aimed to determine the prevalence of prehypertension, hypertension, prediabetes, diabetes, overweight, and obesity among workers at a private tertiary...

Submitral aneurysm is a rare cardiac malformation commonly reported in young adult African ancestry. Transthoracic echocardiogram is a gold standard test for diagnosis. Magnetic resonance imaging provides detailed anatomic and functional information of the heart. We present a case of a large bilobed submitral aneurysm in-witch the magnetic resonanc...

Background: We report a surgical series of submitral aneurysm in children. Methods: Between March 2011 and December 2015, eight consecutive patients less than 18 years old with submitral aneurysm underwent surgical correction. Results: Six patients were female, the mean age was 7 ± 3.8 years old, and mean weight was 21.4 kg. Six patients were...

Obstructive jaundice as an initial manifestation of uterine cancer is extremely rare. We present a case of a 72-year-old female who presented with obstructive jaundice, supposedly for pancreatic cancer. After detailed diagnostic investigation, the cause of the jaundice was attributed to a metastatic compression of the common bile duct, from the pri...

Aortic dissection is a relatively uncommon and potentially misdiagnosed disease. Early and accurate diagnosis and also treatment for patient survival are required. We report at 62-years-old men with diagnosis of Stanford Type A acute aortic dissection misdiagnosed as a hypertensive crisis. He was promptly referred to surgery. According to retro-inf...

We report an incidental finding of pseudoaneurysm in a 10-month-old boy with tetralogy of Fallot and Down syndrome who had undergone placement of a modified Blalock-Taussig shunt at age four months. Computed tomography was a determinant exam for better assessment. The lesion was successfully resected with concomitant complete repair of tetralogy of...

Background Anomalous origin of one pulmonary artery is a rare congenital heart disease in which one pulmonary artery branch originates from the ascending aorta. Objective To describe the experience of a cardiothoracic center in an African country to repair anomalous origin of one pulmonary artery in the context of Portugal–Angola collaboration. M...

Introduction and objective: Ebstein's anomaly is a rare complex congenital heart defect of the tricuspid valve. We aimed to describe the frequency, clinical profile, and early and short-term post-operative results in patients under the age of 18 years operated for this anomaly in a tertiary center in Angola. Methods: A retrospective cross-sectio...

We describe the case of a 9-year-old boy with uncorrected tetralogy of Fallot who presented with seizures at the computed tomography room during the preparation for cardiac computed tomography angiography in order to characterize the cardiac defect. The cardiac computed tomography angiography was suspended, and a brain computed tomography without c...

Introdução e objectivo Esta é a primeira pesquisa em Angola com o objetivo de caracterizar a comunicação interventricular entre crianças e adolescentes. Métodos Estudo transversal, com base nos registos ecocardigráficos do maior Hospital de Cardiologia Pediátrica em Angola (abril de 2010 para março de 2011). Todas as crianças e adolescentes (0 a 1...

Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, s...

A colecistite aguda acalculosa é uma manifestação gastrointestinal rara no lúpus eritematoso sistêmico e ainda mais rara como manifestação inicial. Foram descritos apenas dois casos até o momento. Os autores relatam o caso de uma mulher negra de 20 anos, com quadro de colecistite aguda acalculosa revelada pela tomografia computadorizada do abdome....