51
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Azeka E, Auler Júnior JOC, Fernandes PMP, Nahas WC, Fiorelli AI, Tannuri U, Cristofani LM, Caiero MT, Dulley FL, Paggiaro ADO, Bacchella T. Registry of Hospital das Clínicas of the University of São Paulo Medical School: first official solid organ and tissue transplantation report - 2008. Clinics (Sao Paulo) 2009; 64:127-34. [PMID: 19219318 PMCID: PMC2666479 DOI: 10.1590/s1807-59322009000200010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 10/16/2008] [Accepted: 10/29/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53% to 88%. CONCLUSION This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.
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Affiliation(s)
- Estela Azeka
- Solid Organ and tissue Transplantation Committee, University of São Paulo Medical School, São Paulo/SP, Brazil.
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Barbosa NDF, Azeka E, Aiello VD, Viana F, Jatene M, Tanamati C, Marcial MB. Isolated left ventricular noncompaction: unusual cause of decompensated heart failure and indication of heart transplantation in the early infancy--case report and literature review. Clinics (Sao Paulo) 2008; 63:136-9. [PMID: 18297218 PMCID: PMC2664197 DOI: 10.1590/s1807-59322008000100022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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53
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Fernandes PMP, Azeka E, Odoni V, Junqueira JJM, Bento GP, Aiello V, Barbero-Marcial M. Post-transplantation lymphoproliferative disorder in pediatric patient. Arq Bras Cardiol 2006; 87:e108-11. [PMID: 17128294 DOI: 10.1590/s0066-782x2006001700026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 12/28/2005] [Indexed: 11/22/2022] Open
Abstract
Immunosuppressive therapy for transplanted patients exposes them to a high risk of developing posttransplantation lymphoproliferative disorders (PTLD). We report the case of a child undergoing heart transplantation at seven months of age who developed PTLD at nine years of age, diagnosed by resection of a pulmonary nodule.
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Azeka E. [The impact of L-carnitine on nutritional status in juvenile idiopathic dilated cardiomyopathy]. J Pediatr (Rio J) 2005; 81:355-6. [PMID: 16247533 DOI: 10.2223/jped.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bocchi EA, Vilas-Boas F, Perrone S, Caamaño AG, Clausell N, Moreira MDCV, Thierer J, Grancelli HO, Serrano Junior CV, Albuquerque D, Almeida D, Bacal F, Moreira LF, Mendonza A, Magaña A, Tejeda A, Chafes D, Gomez E, Bogantes E, Azeka E, Mesquita ET, Reis FJFB, Mora H, Vilacorta H, Sanches J, Souza Neto DD, Vuksovic JL, Moreno JP, Aspe y Rosas J, Moura LZ, Campos LADA, Rohde LE, Javier MP, Garrido Garduño M, Tavares M, Castro Gálvez P, Spinoza R, Castro de Miranda R, Rocha RM, Paganini R, Castano Guerra R, Rassi S, Lagudis S, Bordignon S, Navarette S, Fernandes W, Pereira Barretto AC, Issa V, Guimarães JI. I Latin American Guidelines for the Assessment and Management of Decompensated Heart Failure. Arq Bras Cardiol 2005; 85 Suppl 3:49-48. [PMID: 16211166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
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56
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Bocchi EA, Vilas-Boas F, Perrone S, Caamaño AG, Clausell N, Moreira MDCV, Thierer J, Grancelli HO, Serrano Junior CV, Albuquerque D, Almeida D, Bacal F, Moreira LF, Mendonza A, Magaña A, Tejeda A, Chafes D, Gomez E, Bogantes E, Azeka E, Mesquita ET, Reis FJFB, Mora H, Vilacorta H, Sanches J, Souza Neto DD, Vuksovic JL, Paes Moreno J, Aspe y Rosas J, Moura LZ, Campos LADA, Rohde LE, Parioma Javier M, Garrido Garduño M, Tavares M, Castro Gálvez P, Spinoza R, Miranda RCD, Rocha RM, Paganini R, Guerra RC, Rassi S, Lagudis S, Bordignon S, Navarette S, Fernandes W, Barretto ACP, Issa V, Guimarães JI. I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada. Arq Bras Cardiol 2005. [DOI: 10.1590/s0066-782x2005002200001] [Citation(s) in RCA: 2] [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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Abstract
As improved understanding of transplant-related death should improve survival, we report a single center's experience with pediatric heart transplantation including potential risk factors and causes of death during the early postoperative period. This prospective longitudinal study involved 51 pediatric patients ranging in age from 12 days to 15.1 yr (median: 3 yr). The following pretransplant risk factors were evaluated: diagnosis, age at transplantation, recipient sex, weight and blood type, blood type match, donor/recipient sex match, weight ratio, ischemic time, recipient's status, requirement for mechanical ventilation or circulatory support, dialysis, or inotropic support at transplantation. We also determined the actuarial survival, clinical outcomes, and causes of death in this population. Survival was 86% during the early postoperative period (</=30 days), 79.3% at 1 yr, and 76.8% at 3 yr. Seven patients died during the early postoperative period (primary graft failure, rejection, and infection). However, there was no difference in the frequency of any of the risk factors analyzed between these patients and those who did not experience early death. There was a correlation between the duration of intubation after transplantation and pretransplant risk factors (diagnosis, recipient status, requirement for dialysis, inotropic and mechanical ventilation support). Our findings indicate that promising short-term results can be obtained with pediatric transplantation. Although we identified no specific risk factors in this study for death, improved rejection surveillance and treatment strategies remain important goals in pediatric heart transplantation. Retransplantation had high mortality during the perioperative period.
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Affiliation(s)
- Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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58
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Jatene MB, Azeka E, Atik E, Riso A, Tanamati C, Marcial MB, de Oliveira SA. Ascending Aortic Aneurysm After Pediatric Heart Transplantation: Case Report of an Unusual Complication. J Heart Lung Transplant 2005; 24:638-41. [PMID: 15896768 DOI: 10.1016/j.healun.2004.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2002] [Revised: 02/03/2004] [Accepted: 03/01/2004] [Indexed: 11/20/2022] Open
Abstract
A 28-month-old boy, weighing 11 kg, with severe dilated cardiomyopathy, was transplanted on December 1995. Hypertension and supraventricular tachycardia were detected in the immediate post-operative period, with favorable outcome. After 5 months of clinically asymptomatic follow-up, a dilation in the ascending aorta was observed on routine echocardiogram. Nuclear magnetic resonance imaging (NMRI) confirmed an ascending aortic aneurysm, with a diameter of 38 mm. An operation was performed, a bovine pericardium patch was sutured with reconstruction of the aortic wall, excluding the aneurysm. Good recovery was obtained and the child was discharged on Day 7 postoperatively. A post-operative echocardiogram showed absence of the aortic aneurysm and good surgical results. Another NMRI was done 5 months later, showing an intact ascending aorta. After 64 months, the patients clinical condition was confirmed as normal by echocardiogram. Surgical treatment was successful and the positive results have been maintained.
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Nozawa E, Azeka E, Ignêz Z M, Feltrim Z, Auler Júnior JOC. Factors Associated With Failure of Weaning From Long-term Mechanical Ventilation After Cardiac Surgery. Int Heart J 2005; 46:819-31. [PMID: 16272773 DOI: 10.1536/ihj.46.819] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this prospective, quantitative, comparative study, conducted at the 55 bed cardiothoracic intensive care unit of the Heart Institute (InCor), University of Sao Paulo Medical School, was to identify factors involved in the weaning of patients who require long-term (> 10 days) mechanical ventilation after cardiac surgery. The subjects included all patients who underwent open-heart surgery with cardiopulmonary bypass during a 10 month period from April 2000 to January 2001 (n = 946). From this group, 52 (5.7%) patients who required a tracheotomy for the management of long-term mechanical ventilation after cardiac surgery with cardiopulmonary bypass were selected. Pre-, intra- and postoperative data from patients who were not successfully weaned after reintubation and who underwent an elective tracheotomy were compared. Parameters of respiratory mechanics such as respiratory complications, oxygenation, and cardiac, renal, and neurological function were evaluated. Weaning success was defined as the ability of a patient to tolerate 48 hours without pressure or flow support from a mechanical ventilator. A patient was considered to have failed weaning if they died or remained under ventilation for more than 8 weeks. Of the 52 patients studied, 25 were successfully weaned, 21 died, and 6 remained ventilated for more than 8 weeks. We found significant statistical differences (P < 0.05) between the groups with respect to success or failure in LVEF (P = 0.0035), the need for vasoactive agents (P = 0.0018), and renal failure (P = 0.002). Parameters of respiratory mechanics and oxygenation (eg, static airway compliance, airway resistance) did not influence the success or failure of weaning. There was a significant difference in relation to the presence of pneumonia (P = 0.0086) between the two groups. Although neurological complications were more frequent in patients in the weaning success group, the failure group had lower GCS scores, which is indicative of worse prognoses. It is concluded that cardiac dysfunction, the need for dialysis, and pneumonia are determinants for weaning failure in patients undergoing long-term mechanical ventilation after cardiac surgery.
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Affiliation(s)
- Emilia Nozawa
- Division of Anesthesia, Surgery and Physiotherapy, Heart Institute (InCor) Hospital das Clinicas, University of Sao Paulo School of Medicine, Brazil
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60
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Azeka E, Franchini Ramires JA, Valler C, Alcides Bocchi E. Delisting of infants and children from the heart transplantation waiting list after carvedilol treatment. J Am Coll Cardiol 2002; 40:2034-8. [PMID: 12475466 DOI: 10.1016/s0735-1097(02)02570-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We performed a prospective, randomized, double-blind, placebo-controlled study of carvedilol effects in children with severe, chronic heart failure (HF), despite the use of conventional therapy. BACKGROUND Little is known about the effects of carvedilol in youngsters with chronic HF and severe left ventricular (LV) dysfunction. METHODS We conducted a double-blind, placebo-controlled study of 22 consecutive children with severe LV dysfunction. The children had chronic HF and left ventricular ejection fraction (LVEF) <30%. Patients were randomly assigned to receive either placebo (8 patients) or the beta-blocker carvedilol (14 patients) at 0.01 mg/kg/day titrated up to 0.2 mg/kg/day, followed-up for six months. RESULTS During the follow-up and the up-titration period in the carvedilol group, four patients died and one underwent heart transplantation. In patients receiving carvedilol evaluated after six months, a significant increase occurred in LVEF, from 17.8% (95% confidence interval [CI], 14.1 to 21.4%) to 34.6% (95% CI, 25.2 to 44.0%); p = 0.001. Modified New York Heart Association (NYHA) functional class improved in nine patients taken off the transplant waiting list. All nine patients were alive at follow-up. In the placebo group, during the six-month follow-up, two patients died, and two underwent heart transplantation. Four patients persisted with HF symptoms (NYHA functional class IV). No significant change occurred in LVEF or fractional shortening. CONCLUSIONS Carvedilol added to standard therapy may reduce HF progression and improve cardiac function, allowing some youngsters to be removed from the heart transplantation waiting list.
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Affiliation(s)
- Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo,
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61
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Sylos CD, Pereira AC, Azeka E, Miura N, Mesquita SMF, Ebaid M. Arterial hypertension in a child with Williams-Beuren syndrome (7q11.23 chromosomal deletion). Arq Bras Cardiol 2002; 79:173-80. [PMID: 12219191 DOI: 10.1590/s0066-782x2002001100009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 7-year-old male child diagnosed with Williams-Beuren syndrome and arterial hypertension refractory to clinical treatment. The diagnosis was confirmed by genetic study. Narrowing of the descending aorta and stenosis of the renal arteries were also diagnosed. Systemic vascular alterations caused by deletion of the elastin gene may occur early in individuals with Williams-Beuren syndrome, leading to the clinical manifestation of systemic arterial hypertension refractory to drug treatment.
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Affiliation(s)
- Cristina de Sylos
- Instituto do Carcao do Hospital das Clinical, Sao Paulo, Brazil. crsylos@netpoint .com.br
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62
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Azeka E, Marcial MB, Jatene M, Auler JOC, Ramires JAF. Eight-year experience of pediatric heart transplantation: clinical outcome using non-invasive methods for the evaluation of acute rejection. Pediatr Transplant 2002; 6:208-13. [PMID: 12100504 DOI: 10.1034/j.1399-3046.2002.01075.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Combined immunosuppression therapy and acute rejection surveillance after heart transplantation may influence clinical outcome. This prospective, longitudinal study investigated 27 pediatric patients (12 days to 12 yr of age; mean 3.0 yr) who underwent a post-operative regimen that included long-term treatment with cyclosporin A and azathioprine (double immunosuppression) and polyclonal anti-thymocyte serum induction therapy. Non-invasive parameters were used to diagnose acute rejection. The actuarial survival, clinical outcomes, and complications were analyzed. The actuarial survival after double immunosuppression and induction therapy with polyclonal anti-thymocyte serum was 89%, 73%, and 57% at 1, 4, and 8 yr, respectively. The rejection frequency was 2.6 episodes/patient and the infection frequency, 3.7 episodes/patient. One year after transplantation, systemic arterial hypertension was detected in 21% of patients. Hence, double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide promising clinical outcome in pediatric heart transplant recipients.
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Affiliation(s)
- Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
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63
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Azeka E, Costa Auler JO, Kajita L, Alliman AC, Franchini Ramires JAA, Ebaid M. Effects of low doses of inhaled nitric oxide combined with oxygen for the evaluation of pulmonary vascular reactivity in patients with pulmonary hypertension. Pediatr Cardiol 2002; 23:20-6. [PMID: 11924533 DOI: 10.1007/s00246-001-0006-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to evaluate the hemodynamic effects of inhaled nitric oxide in oxygen (NO + O2) in patients with pulmonary hypertension. Eighteen patients (median age 31.5 months) with pulmonary hypertension inhaled through a mask 100% O2 and 20 parts per million NO + inspired O2 fraction (FiO2) at 0.4. Hemodynamic measurements were made at baseline and after O2 and NO + O2 administration. The pulmonary vascular resistance index decreased after inhalation of O2 and NO + O2 (p = 0.0018 and p = 0.0003, respectively), the decrease being significantly greater after NO + O2 (p = 0.0311). Concerning the transpulmonary pressure gradient, a reduction occurred in values after O2 and NO + O2 inhalation when compared with baseline values (p = 0.0014 and p = 0.0008). In patients with congenital heart disease, an increase occurred in pulmonary blood flow after O2 (p = 0.0089) and NO + O2 (p = 0.0019) compared with baseline values, and an increase also occurred in the pulmonary/systemic blood flow ratio after NO + O2 (p = 0.0017). The main side effect related to NO + O2 was pulmonary congestion in 3 patients. Low doses of NO combined with O2 demonstrated a selective pulmonary vasodilator response in patients with pulmonary hypertension. Despite its use for testing pulmonary reactivity, inhalation of NO + O2 should be carefully administered because of the potential risk of pulmonary congestion.
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Affiliation(s)
- E Azeka
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
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64
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Ikari NM, Azeka E, Aiello VD, Atik E, Barbero-Marcial M, Ebaid M. Uhl's anomaly. Differential diagnosis and indication for cardiac transplantation in an infant. Arq Bras Cardiol 2001; 77:69-76. [PMID: 11500750 DOI: 10.1590/s0066-782x2001000700008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report the case of an 8-month-old female infant with Uhl's anomaly, who underwent successful cardiac transplantation. The clinical findings, complementary laboratory tests, anatomic findings, and differential diagnosis of the anomaly are discussed.
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Affiliation(s)
- N M Ikari
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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65
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Azeka E, Ramires JA, Ebaid M, Bocchi E. Clinical outcome after starting carvedilol in infants and children with severe dilated cardiomyopathy candidates for heart transplantation. J Heart Lung Transplant 2001; 20:222. [PMID: 11250416 DOI: 10.1016/s1053-2498(00)00487-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- E Azeka
- Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, São Paulo, Brazil
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66
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Azeka E, Barbero-Marcial M, Jatene M, Camargo PR, Auler JO, Atik E, Ramires JA, Ebaid M. Heart transplantation in neonates and children. Intermediate-term results. Arq Bras Cardiol 2000; 74:197-208. [PMID: 10951823 DOI: 10.1590/s0066-782x2000000300002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess intermediate-term outcome in children who have undergone orthotopic heart transplantation. METHODS We carried out a longitudinal and prospective study between October '92 and June '99 comprising 20 patients with ages ranging from 12 days to 7 years (mean of 2.8 years). We employed a double immunosuppression protocol with cyclosporine and azathioprine and induction therapy with polyclonal antithymocyte serum. Survival and complications resulting from the immunosuppression protocol were analyzed. RESULTS The double immunosuppression protocol and the induction therapy with polyclonal antithymocyte serum resulted in an actuarial survival curve of 90% and 78.2% at 1 and 6 years, respectively, with a mean follow-up period of 3.6 years. One patient died due to acute rejection 40 days after transplantation; another patient died 2 years after transplantation due to lymphoproliferative disorder; a third patient died because of primary failure of the graft; and a fourth patient died due to bronchopneumonia. The major complications were as follows: acute rejection, infection, nephrotoxicity, and systemic hypertension. The means of rejection and infection episodes per patient were 2.9 and 3.4, respectively. After one year of transplantation, a slight reduction in the creatinine clearance and systemic hypertension were observed in 7 (38.9%) patients. CONCLUSION Heart transplantation made life possible for those patients with complex congenital heart diseases and cardiomyopathies in refractory congestive heart failure constituting a therapeutical option for this group of patients in the terminal phase.
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Affiliation(s)
- E Azeka
- Instituto do Coração do Hospital das Clínicas-FMUSP and Hospital Sírio Libanês-São Paulo, Brazil
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67
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Azeka E, Loures DR, Jatene MB, Favarato ME. [I Guidelines of the Brazilian Cardiology Society for Heart Transplantation: II. Heart transplantation in children]. Arq Bras Cardiol 1999; 73 Suppl 5:6-11. [PMID: 10883477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Abstract
Ebstein's anomaly with coarctation of the aorta is an extremely unusual condition. In this report, the clinical and surgical features of 3 male patients, aged 7 months, 4 years and 14 years, are discussed. All patients were in situs solitus. The first 2 patients had atrioventricular and ventriculoarterial discordance and progressed to heart failure in the neonatal period. The third had atrioventricular and ventriculoarterial concordance, as well as Wolf-Parkinson-White syndrome, with frequent episodes of paroxysmal tachycardia. The 3 patients underwent surgery for correction of the coarctation of the aorta. The patient with atrioventricular and ventriculoarterial concordance underwent tricuspid valvuloplasty using a DeVega-like technique. In addition, ablation of 2 anomalous pathways (Kent bundle), which were detected by the electrophysiologic study, was also subsequently performed. The 3 patients showed a good postoperative outcome for 2 years, although, in those with discordance, the surgical procedure did not influence the dysplasia of the tricuspid valve, because this valve showed light to moderate dysfunction.
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Affiliation(s)
- M Ebaid
- Instituto do Coração do Hospital das Clínicas, FMUSP, Brazil
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69
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Azeka E, Marcial MB, Camargo PR, Kajita L, Aliman AC, Auler JO, Atik E, Ebaid M. [Hemodynamic evaluation and clinical outcome of children with severe dilated cardiomyopathy eligible for heart transplantation]. Arq Bras Cardiol 1998; 71:661-6. [PMID: 10347948 DOI: 10.1590/s0066-782x1998001100004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate hemodynamic parameters and clinical outcome of children with severe cardiomyopathy who are candidates for heart transplantation. METHODS Twenty four children aged from 4 months to 10 years and 8 months (mean 3.7 +/- 2.5 years) from February 1992 to May 1996, were submitted to hemodynamic study and the following parameters were measured: cardiac output, mean pulmonary artery pressure (MPAP) and capillary wedge pressure. The pulmonary vascular resistance index (PVRI) and transpulmonary pressure gradient (TGP) were calculated. RESULTS Ten (41.6%) children were transplanted (group A), 5 (20.8%) are still waiting heart transplantation (group B) and 9 (37.6%) died (group C). The mean age of the B and C group were significantly different. The PVRI, MPAP and TPG were significant lower in group A than group C (p = 0.01; p = 0.044 and p = 0.023 respectively). CONCLUSION The profile of the hemodynamic parameters of children with severe dilated cardiomyopathy was compatible with the clinical findings. The age was the only difference comparing groups B and C. PVRI, MPAP and TPG were significant factors between group A and C. The older the patient, the worse was the prognosis.
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Affiliation(s)
- E Azeka
- Instituto do Coração do Hospital das Clínicas, FMUSP
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70
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Abstract
Eleven children, 4-48 months old, with congenital cyanotic heart defects developed choreoathetoid movements 2-12 days after cardiac surgery with hypothermia and extracorporeal circulation (ECC). The abnormal movements mainly involved the limbs, facial musculature, and tongue, leading to a severe dysphagia. The symptoms had an acute onset, after a period of apparent neurologic normality, and had a variable outcome. Of the nine children that survive, three had abnormal movements when last seen (41 days to 12 months of follow-up). The other six children had a complete regression of the choreoathetoid movements 1-4 weeks after onset. No specific finding was observed in the CT scans, cerebrospinal fluid examination, or EEG that could be related to the abnormal movements. Symptomatic therapy with haloperidol with or without benzodiazepines led to symptomatic improvement in six children, although there was no evidence that this treatment modified the evolution of the disease. The authors conclude that the choreoathetoid syndrome after cardiac surgery with deep hypothermia and ECC is an ill-defined entity requiring additional study to better understand its pathogenesis so that preventive measures can be taken to avoid a condition that can lead to permanent and incapacitating neurologic sequelae.
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Affiliation(s)
- J L Gherpelli
- Department of Child Neurology, Clinics Hospital of the University of São Paulo Medical School, SP, Brazil
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71
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Aiello VD, Fukasawa S, da Silva MJ, Azeka E, Bosisio IB, Ebaid M, Higuchi ML. [Systematic quantification of the arteries in lung biopsies of patients with congenital heart defects and its contribution to the therapeutic management]. Arq Bras Cardiol 1997; 68:3-8. [PMID: 9334452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To determine the value of the quantitative analysis of lung biopsies from patients with congenital cardiac defects. METHODS Fourty nine biopsies were examined, from patients: 43 patients increased pulmonary blood flow, 3 with pulmonary atresia and large systemic-to-pulmonary collateral vessels, and 3 with decreased pulmonary flow. The degree of lesion was determined as in Heath-Edwards and of Rabinovitch and col. RESULTS The Heath and Edwards grade was determined in 41 cases; I in nine; II in 23; III in eight; IV in one; 3 biopsies showed evidence of reduced pulmonary flow and 5 had no signs of vascular disease. The Down patients (7) presented a greater proportion of severe lesions. Quantitative evaluation was obtained in 35 biopsies: 11 had grade B and 24 had grade C. Wall atrophy and dilatation of intraacinar arteries were detected in 7 cases, what suggested the existence of obstructive lesions in proximal vessels, even if not sampled. Medical thickness greater than 2 times the normal were observed in pre-acinar arteries from 14 biopsies. CONCLUSION The morphometric approach allowed us to detect severe lesions which the qualitative analysis alone would not indicate adequately. In the patients presenting decreased pulmonary flow, morphometry made possible to assess if the degree of arterial wall hypertrophy was compatible with a surgery of atrio-pulmonary anastomosis.
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Affiliation(s)
- V D Aiello
- Instituto do Coração do Hospital das Clínicas, FMUSP e Hospital do Coração do Sanatório Sírio, São Paulo
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Barbero-Marcial M, Azeka E, Camargo PR, Riso A, Jatene M, Soares J, Snitcowsky R, Auler Júnior JO, Camargo L, Santos S, Coelho V, Atik E, Ebaid M, Jatene A. [Neonate and infant heart transplantation]. Arq Bras Cardiol 1996; 67:165-70. [PMID: 9181709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Heart transplantation has offered children with complex congenital heart diseases and severe cardiomyopathies a chance for survival. The present article was written to show the three year experience of this procedure at the Instituto do Coração-HCFMUSP. METHODS The methodology used was based on heart transplant indication criteria, inclusion criteria for donors, postoperative management, immunosuppression and prophylaxis as well as treatment of potential complications. RESULTS From November 1992 to November 1995, 11 children, aged 12 days old to six years (mean 2.5 years) underwent transplantation. Sixty percent of recipients were male; weight ranged from 3.5 to 17.8 kg (mean 10.3 kg). The mean age of donors was 4.4 years (a range of three weeks to ten years), 80% male, weight ranging from 3.8 to 20 kg (median 14.3 kg). The survival rate was 91% and the remaining 10 children are doing well. The most important complications were systemic hypertension, acute rejection and infection. The number of rejections and infections per patient were 3.5 and 4.7 episodes, respectively. The follow-up was between one month to three years (average 16 months). CONCLUSION In this experience, heart transplantation has given an additional opportunity for children with complex congenital heart diseases and cardiomyopathies, with a survival rate of 91% in three years.
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Barbero-Marcial M, Azeka E, Camargo PR, Jatene MB, Riso A, Auler Júnior JOC, Soares J, Monteiro C, Uip D, Camargo L, Santos S, Coelho V, Atik E, Ebaid M, Jatene AD. Características do transplante cardíaco neonatal e infantil. Braz J Cardiovasc Surg 1996. [DOI: 10.1590/s0102-76381996000200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Azeka E, Ikari NM, Kajita LJ, Foronda A, Ebaid M. [Ischemic cardiomyopathy in a child. Case report with accentuated coronary disease]. Arq Bras Cardiol 1993; 60:39-42. [PMID: 8240041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Ischemic cardiomyopathy in childhood is related with congenital and acquired pathologies which could lead to serious cardiac sequelae as myocardial infarction and sudden death. Unfortunately, when coronary artery malformations are excluded, it is difficult in some cases to be completely certain on the etiology of the arterial coronary disease, due the lack of pathognomonic diagnostic tests. Case report of 6 year old child, with severe coronary artery disease: aneurysm of main branch of left coronary artery; left anterior descending branch and right coronary artery occlusions with accentuated myocardial dysfunction. We believe that the diagnosis of Kawasaki disease is presumptive in this patient. The principal aspects to elucidate the etiology of coronary artery disease are analysed, as well as the importance of identifying patients without known previous illness, but with severe coronary artery lesions, as in this reported case.
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Affiliation(s)
- E Azeka
- Instituto do Coração do Hospital das Clínicas-FMUSP
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75
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Azeka E, Iwahashi ER, Atik E, Barrera PG, Aiello VD, Ebaid M. [Functional atresia of the pulmonary valve]. Arq Bras Cardiol 1992; 58:121-3. [PMID: 1307457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Three newborn children with cyanosis due to Ebstein's anomaly of tricuspid valve with an important hemodynamic repercussion presented features of imperforation of pulmonary valve. On the follow-up, clinical and laboratory findings verified that pulmonary atresia was functional resulting from a combination of low right ventricular pressure and high pulmonary vascular resistance.
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Affiliation(s)
- E Azeka
- Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo
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