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Justo Pereira R, Lemos M, Sampaio Graça I, Nogueira G, Anjos R. Clips on the X-ray: Expect the unexpected. Rev Port Cardiol 2024; 43:95-96. [PMID: 37652116 DOI: 10.1016/j.repc.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Rita Justo Pereira
- Department of Pediatrics, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
| | - Mariana Lemos
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Isabel Sampaio Graça
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Graça Nogueira
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Rui Anjos
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
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Fogaça da Mata M, Anjos R, Lemos M, Nelumba T, Cordeiro S, Rato J, Teixeira A, Abecasis M. Prenatal diagnosis of coarctation: Impact on early and late cardiovascular outcome. Int J Cardiol 2024; 396:131430. [PMID: 37827282 DOI: 10.1016/j.ijcard.2023.131430] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Prenatal diagnosis (PND) of aortic coarctation (AoCo) has been associated with a significant improvement in early results, but there is limited information on the long-term cardiovascular outcome. METHODS We studied 103 patients with simple AoCo, operated in the neonatal period, with a median follow-up of 8,5 years (2 to 23,7 years), with 47% followed for over 10 years. PND was made in 35%. The primary aim was to determine the short and long-term cardiovascular impact of PND of AoCo. RESULTS Neonates with PND had less preoperative neonatal complications, with only 2,8% incidence of a composite preoperative severe morbidity course, compared to 28% in the postnatal group. PND patients underwent surgery 8 days earlier and had a shorter length of stay in ICU. PND did not impact the incidence of post-operative complications. On the long-term, prevalence of hypertension, left ventricular hypertrophy and rate of recoarctation were not influenced by PND. The PND group had mean 24 h diastolic BP 9 mmHg lower and mean daytime diastolic BP 11 mmHg lower. In the final multivariable model, PND was the single independent variable correlating with daytime diastolic BP. CONCLUSION PND of AoCo effectively leads to a better pre-operative course with less pre-operative morbidity. We found no significant differences in immediate post-operative cardiovascular outcomes. A better initial course of patients with PND does not have a major long-term impact on cardiovascular outcomes, nevertheless, at late follow-up PND patients had lower diastolic BP values on ambulatory monitoring, which may have an impact on long-term cardiovascular risk.
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Affiliation(s)
- Miguel Fogaça da Mata
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
| | - Rui Anjos
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Mariana Lemos
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Tchitchamene Nelumba
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Susana Cordeiro
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - João Rato
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ana Teixeira
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Miguel Abecasis
- Pediatric Cardiac Surgery Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Lemos M, Rato J, da Mata MF, Sequeira M, Mendes SC, Anjos R. Diastolic Function and Left Atrial Strain in Young Patients with History of Aortic Coarctation Repair. Pediatr Cardiol 2023; 44:674-680. [PMID: 36028777 DOI: 10.1007/s00246-022-02992-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
Aortic coarctation (AoCo) leads to long-term sequelae that may impair heart function. Data regarding new echocardiographic function parameters such as atrial strain, in affected patients, are scarce. This study aims to describe these parameters in AoCo patients and define their association with severity measures. 53 AoCo patients and 31 healthy controls, aged 12-40 years, were evaluated. Effectively corrected AoCo (cAoCo) was defined as aortic trans-isthmic corrected Doppler gradient (Dgrad) ≤ 20 mmHg (n = 36), and recoarctation (rAoCo) as Dgrad > 20 mmHg (n = 17). Dependent variables were: E/E'; atrial reservoir strain (Ares); and atrial conduit strain (Acd). T-tests/Mann-Whitney U tests were used to compare these among groups. Multivariable regression was used to test correlation with systolic blood pressure (SBP), indexed LV mass (ILVM), Dgrad, and the ratio between the narrowest diameter of aortic arch and aorta at diaphragm level (Aoratio). In cAoCo and rAoCo patients, E/E' was higher (p < 0.001), Ares, and Acd were lower (p < 0.001 for both) comparing with controls. Acd was higher in cAoCo than rAoCo (p = 0.045). Higher Ares was associated with higher Aoratio (p = 0.002), and lower Acd with higher Dgrad (0.014). EF and GLS were not different among groups. Young patients with effectively corrected aortic coarctation have persistent changes in diastolic function parameters (E/E' and atrial strain), and these are affected by anatomical sequelae. These patients' physiology is closer to patients with recoarctation, than to healthy individuals. This provides rationale for a stronger prevention, and treatment, of arterial dysfunction and high left ventricular afterload in these patients.
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Affiliation(s)
- Mariana Lemos
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - João Rato
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.
| | - Miguel Fogaça da Mata
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Mafalda Sequeira
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Susana Cordeiro Mendes
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Rui Anjos
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
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Carrington M, Pereira AR, Mendes IC, Anjos R. Intracardiac versus extracardiac shunt in a young man with ischaemic stroke. BMJ Case Rep 2022; 15:e247877. [PMID: 35260403 PMCID: PMC8905973 DOI: 10.1136/bcr-2021-247877] [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] [Accepted: 01/26/2022] [Indexed: 11/03/2022] Open
Abstract
A 24-year-old man with a history of recent ischaemic stroke was diagnosed with patent foramen ovale (PFO) and referred for closure at our hospital. At admission, besides low peripheral oxygen saturation (88%), physical examination was otherwise normal. We performed intraprocedural transoesophageal echocardiogram that revealed no PFO, although agitated saline injection demonstrated bubbles lately on the left atrium. The atrial septum could not be crossed. We suspected an extracardiac shunt, so pulmonary angiograms were performed that revealed the presence of a left pulmonary arteriovenous malformation (PAVM). A Konar-MF Occluder was used to occlude the PAVM, with a satisfactory result. At 6 months follow-up, the patient had normal peripheral oxygen saturation and a new pulmonary angiogram showed no residual shunt. Intrapulmonary shunts are a rare and under-recognised cause of paradoxical emboli in young patients; physicians should be aware of this diagnosis as percutaneous occlusion is indicated and critical to avoid recurrent ischaemic episodes.
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Affiliation(s)
| | | | - Inês Carmo Mendes
- Pediatric Cardiology Department and Reference Center for Congenital Heart Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Lisboa, Portugal
| | - Rui Anjos
- Pediatric Cardiology Department and Reference Center for Congenital Heart Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Lisboa, Portugal
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5
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Ataíde Silva R, R Sousa A, de Carvalho MSL, Anjos R. Congenital long QT syndrome presenting as unexplained bradycardia. BMJ Case Rep 2022; 15:e242362. [PMID: 35236671 PMCID: PMC8895896 DOI: 10.1136/bcr-2021-242362] [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] [Accepted: 02/08/2022] [Indexed: 11/03/2022] Open
Abstract
Congenital long QT syndrome (LQTS) is a genetically autosomal heterogeneous disorder of the ion channels and causes about 10% of sudden death infant syndrome in newborns. Its estimated prevalence is approximately 1 in 2500, probably underestimated because of its clinical heterogenicity. Few cases of neonatal LQTS have been reported. In 4% of them, life-threatening arrhythmic events can be the first manifestation of LQTS. The authors report two cases of neonatal LQTS with heterogeneous genetic mutations. Both manifested by bradycardia, one since fetal life. One case had serious arrhythmias during beta blocker therapeutic establishment needing a pacemaker implantation. Genetic mutations found were not the most frequently described in association with neonatal bradycardia, thus the importance of this report. Presentation with bradycardia is relatively frequent in neonatal period, thus LQTS should be actively investigated in neonates with unexplained bradycardia. Beta blocker therapy reduces QTc and avoids arrhythmic events and sudden death.
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Affiliation(s)
- Rita Ataíde Silva
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
| | - Ana R Sousa
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
| | | | - Rui Anjos
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
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Silva CJ, Madeira S, Abecasis J, Anjos R. Long-standing hypoxaemia in complex adult congenital heart disease: anatomical and functional interplay in an uncommon presentation. BMJ Case Rep 2022; 15:e248330. [PMID: 35236701 PMCID: PMC8895942 DOI: 10.1136/bcr-2021-248330] [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] [Accepted: 01/19/2022] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 28-year-old man lost to follow-up with chronic hypoxaemia and a history of an uncorrected tricuspid hypoplasia, perimembranous ventricular septal defect (VSD) and pulmonary stenosis. Given this initial diagnosis, chronic hypoxaemia was deemed to result from right-to-left shunt through the VSD driven by elevated right ventricle pressures. However, the further investigation identified an inferior sinus venosus atrial septal defect, unveiling the true mechanism behind the clinical scenario. The patient was submitted to surgical correction with clinical improvement. This case illustrates the defiant evaluation of this type of atrial septal defect through echocardiography and underlines the importance of a multimodal evaluation to reach an accurate diagnosis and optimal management.
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Affiliation(s)
- Cláudia Jesus Silva
- Cardiology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Portugal
| | - Sergio Madeira
- Cardiology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Portugal
| | - João Abecasis
- Cardiology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Carnaxide, Portugal
| | - Rui Anjos
- Pediatric Cardiology, Hospital Santa Cruz, Carnaxide, Portugal
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Lemos M, Rato J, Mata M, Sequeira M, Cordeiro Mendes S, Carmo Mendes I, Anjos R. Advanced echocardiographic function analysis in adolescents and young adults with corrected and residual coartation of the aorta. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.292] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
This study aimed to assess systolic and diastolic heart function changes in patients with history of aortic coarctation using advanced echocardiographic imaging. Additionally, we sought to analyse which severity factors influenced these changes.
Methods
We performed a complete echocardiographic evaluation, with advanced functional analysis, including myocardial work analysis, to a random sample of 53 patients (age 12 to 40 years). These had a previous history of coarctation of the aorta (CoAo), which was either corrected (aortic transisthmic Doppler gradient (Dgrad) ≤20mmHg) or presented a significant residual gradient (Dgrad >20mmHg). A control group of healthy individuals, matched for age, sex and BMI, was subjected to the same evaluation. Selected dependent variables were: E/A, E’, E/E’, atrial strain parameters, biplane ejection fraction, ventricular global longitudinal strain, and global myocardial work (GMW). One-way ANOVA with appropriate post-hoc tests was done to compare the distribution of dependent variables among controls (n = 31), patients with corrected coartation (cCOAO) (n = 36), and patients with residual coartation (rCOAO) (n = 17). Multivariable linear regression was used to evaluate the association, in the 53 patients, between the dependent variables and parameters of CoAo severity: systolic blood pressure (SBP), left ventricular indexed mass (LVmass), Dgrad, and the ratio of the narrowest diameter of the aortic arch to the aorta at the diaphragm level (Aoratio). Statistical significance was established as p < 0.05.
Results
Patients with either cCOAO or rCOAO had lower E’ (p < 0.001), higher E/E’ (p < 0.001), lower atrial reservoir (p < 0.001) and conduit (p < 0.001) strain, when compared with controls (table 1). Patients with rCOAO had higher GMW when compared with either cCOAO or controls (p = 0.002). Multivariable regression analysis showed that both lower atrial reservoir and conduit strain were associated with a narrower aortic arch (lower Aoratio (p = 0.002 and p = 0.011, respectively); higher E/E’ with higher LVmass (p = 0.030); higher GMW with higher LVmass (p = 0.027) and Dgrad (p = 0.035). Patients subsequently submitted to an intervention for coartation treatment (n = 8) had lower atrial conduit (p = 0.007) and higher GMW (p = 0.015) when compared to all other patients (n = 45). Conclusion: Myocardial work emerged as a particularly useful tool as it was both significantly different between CoAo groups, and significantly higher in more severe patients, driven by the LV mass and residual gradient. This analysis may have a role in these patients’ clinical decision-making. Abstract Table 1
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Affiliation(s)
- M Lemos
- Hospital Santa Cruz, Lisbon, Portugal
| | - J Rato
- Hospital Santa Cruz, Lisbon, Portugal
| | - M Mata
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | | | - R Anjos
- Hospital Santa Cruz, Lisbon, Portugal
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8
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Fogaça da Mata M, Vieira Martins M, Rato J, Madeira M, Gonçalves JP, Teixeira A, Anjos R. Azacitidine-induced massive pericardial effusion in a child with myelodysplastic syndrome. J Oncol Pharm Pract 2022; 28:975-978. [PMID: 35037800 DOI: 10.1177/10781552211073884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pericardial effusions are rare yet potentially fatal conditions in children. Azacitidine is a DNA-hypomethylating agent used in the treatment of myelodysplastic syndrome. Although seldomly described in adults, no cases of azacitidine-induced pericardial effusion have been reported in children. CASE REPORT A 7-year-old boy with myelodysplastic syndrome presented with a large pericardial effusion with risk for cardiac tamponade after his first azacitidine cycle. MANAGEMENT & OUTCOME The patient was admitted to a pediatric ICU, antibiotic and steroid therapy were initiated. Pericardiocentesis was done due to hemodynamic instability. Serum and pericardial fluid complementary evaluation excluded infectious and malignant causes. The pericardial effusion did not reappear and additional pleural and ascitic slight effusions responded well to diuretics. Follow-up azacitidine cycles were administered by tapering daily dosages and using adjunctive steroid therapy, with no additional adverse events. DISCUSSION We report the first pediatric case of large pericardial effusion secondary to azacitidine therapy in a child with MDS. This adverse reaction has not been described in pediatric patients, in which this therapeutic option has been increasingly used. We seek to raise awareness on the potential life-threatening cardiotoxicity of azacitidine in pediatric patients.
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Affiliation(s)
- Miguel Fogaça da Mata
- Pediatric Cardiology Department, Hospital de Santa Cruz, 70897Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Vieira Martins
- Pediatrics Department, 162181Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - João Rato
- Pediatric Cardiology Department, Hospital de Santa Cruz, 70897Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Márcio Madeira
- Cardiac Surgery Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jean-Pierre Gonçalves
- Pediatrics Department, 37838Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Ana Teixeira
- Pediatric Cardiology Department, Hospital de Santa Cruz, 70897Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Rui Anjos
- Pediatric Cardiology Department, Hospital de Santa Cruz, 70897Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Ait-Ali L, Martins DS, Khraiche D, Festa P, Barison A, Martini N, Benadjaoud Y, Anjos R, Boddaert N, Bonnet D, Aquaro GD, Raimondi F. Cardiac MRI prediction of recovery in children with acute myocarditis. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.06.007] [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: 11/29/2022]
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Magro P, Carvalho N, Anjos R, Neves J. Coronary artery bypass grafting in a child with Kawasaki disease. Rev Port Cardiol 2021; 40:519.e1-519.e4. [PMID: 34274100 DOI: 10.1016/j.repce.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/13/2018] [Indexed: 11/18/2022] Open
Abstract
Kawasaki disease (KD) with cardiac involvement can result in the development of coronary aneurysm, stenosis or thrombosis with significant cardiovascular implications. We report the case of a 23-month-old male with a late diagnosis of KD, in whom intravenous immunoglobulin treatment was not feasible. The patient's course was assessed by routine echocardiography. At the age of five years, angiographic assessment revealed an aneurysm of the anterior descending coronary artery measuring 17 mm×7 mm involving the first diagonal branch, 90% post-aneurysmal stenosis, and an aneurysm of the right coronary artery measuring 32 mm×6 mm. Due to the critical anatomy of the anterior descending artery the revascularization method of choice was coronary artery bypass surgery with an internal mammary artery graft, under cardiopulmonary bypass. There were no significant intraoperative or postoperative complications. This confirms coronary artery bypass grafting as a reliable treatment option for patients who present with coronary sequelae from KD, even at a very young age.
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Affiliation(s)
- Pedro Magro
- Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Portugal.
| | - Nuno Carvalho
- Department of Pediatric Cardiology, Santa Cruz Hospital, Carnaxide, Portugal
| | - Rui Anjos
- Department of Pediatric Cardiology, Santa Cruz Hospital, Carnaxide, Portugal
| | - José Neves
- Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Portugal
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Ataíde Silva R, Martins D, Anjos R. Atrial septal defect closure in conotruncal defects: a cautionary tale. Heart 2021; 106:1217-1280. [PMID: 32719149 DOI: 10.1136/heartjnl-2020-316861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Duarte Martins
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Rui Anjos
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
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12
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Magro P, Carvalho N, Anjos R, Neves J. Coronary artery bypass grafting in a child with Kawasaki disease. Rev Port Cardiol 2021. [PMID: 34083099 DOI: 10.1016/j.repc.2018.05.023] [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
Kawasaki disease (KD) with cardiac involvement can result in the development of coronary aneurysm, stenosis or thrombosis with significant cardiovascular implications. We report the case of a 23-month-old male with a late diagnosis of KD, in whom intravenous immunoglobulin treatment was not feasible. The patient's course was assessed by routine echocardiography. At the age of five years, angiographic assessment revealed an aneurysm of the anterior descending coronary artery measuring 17 mm×7 mm involving the first diagonal branch, 90% post-aneurysmal stenosis, and an aneurysm of the right coronary artery measuring 32 mm×6 mm. Due to the critical anatomy of the anterior descending artery the revascularization method of choice was coronary artery bypass surgery with an internal mammary artery graft, under cardiopulmonary bypass. There were no significant intraoperative or postoperative complications. This confirms coronary artery bypass grafting as a reliable treatment option for patients who present with coronary sequelae from KD, even at a very young age.
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Affiliation(s)
- Pedro Magro
- Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Portugal.
| | - Nuno Carvalho
- Department of Pediatric Cardiology, Santa Cruz Hospital, Carnaxide, Portugal
| | - Rui Anjos
- Department of Pediatric Cardiology, Santa Cruz Hospital, Carnaxide, Portugal
| | - José Neves
- Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Portugal
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13
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Martins DS, Ait-Ali L, Khraiche D, Festa P, Barison A, Martini N, Benadjaoud Y, Anjos R, Boddaert N, Bonnet D, Aquaro GD, Raimondi F. Evolution of acute myocarditis in a pediatric population: An MRI based study. Int J Cardiol 2020; 329:226-233. [PMID: 33359333 DOI: 10.1016/j.ijcard.2020.12.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/21/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac Magnetic Resonance (CMR) data regarding myocarditis presentation and disease course is still lacking in pediatric patients. We evaluate baseline CMR and evolution of functional and tissue abnormalities in children with acute myocarditis. METHODS CMR was performed in 125 patients with clinical diagnosis of acute myocarditis. Clinical follow-up was performed for a median of 498 (214-923) days. RESULTS LVEF was depressed (<55%) in 56 cases (45%) upon baseline CMR. LGE was found in 93 patients (77%) of cases. LGE was exclusively subepicardial in 29 patients (23%), while other LGE patterns (midwall/mixed) were present in 64 (51%). CMR was repeated in 92 (74%) patients. 67% presented recover of function at a median of 170 (70-746) days after onset of symptoms. Midwall/mixed LGE pattern had a statistically significant correlation with absent recover of function (OR 0.20 p 0.036). Thirteen patients (16%) had recovery from LV dysfunction but with persistence of LGE. Sub-epicardial pattern of LGE (OR 3.33, 95% CI 1.08-10.2, p = 0.036) and the presence of fever at admission (OR 4.67, 95% CI 1.16-18.7, p = 0.03) were associated with a significantly higher likelihood of complete normalization while midwall/mixed LGE pattern was associated with non-recovery. CONCLUSIONS In pediatric myocarditis, midwall/mixed LGE pattern is associated with absent recover of function. Patients with recover of function may still have persistence of LGE, while a complete recovery from functional and tissue abnormalities is found only in a third of patients. Midwall/mixed pattern of LGE at first MRI was associated to worse outcome.
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Affiliation(s)
- Duarte S Martins
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France and Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
| | - Lamia Ait-Ali
- Institute of Clinical Physiology CNR, UO Massa and Fondazione G. Monasterio, CNR-Regione Toscana, Italy
| | - Diala Khraiche
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | | | | | | | - Yasmine Benadjaoud
- Laboratory of Embriology and Genetic Malformation, INSERM UMR 1163, Imagine Institute, Université de Paris, F-75015 Paris, France
| | - Rui Anjos
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | - Damien Bonnet
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | | | - Francesca Raimondi
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France and Laboratory of Embriology and Genetic Malformation, INSERM UMR 1163, Imagine Institute, F-75015 Paris, France
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14
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Ait-Ali L, Martins DS, Khraiche D, Festa P, Barison A, Martini N, Benadjaoud Y, Anjos R, Boddaert N, Bonnet D, Aquaro GD, Raimondi F. Cardiac MRI Prediction of Recovery in Children With Acute Myocarditis. JACC Cardiovasc Imaging 2020; 14:693-695. [PMID: 33248957 DOI: 10.1016/j.jcmg.2020.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/28/2022]
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15
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Marinheiro R, Martins D, Mendes I, Anjos R. The role of three-dimensional computed tomography angiography in accurate characterization of multiple pulmonary stenosis. Cardiol J 2020; 27:212-213. [PMID: 32463105 DOI: 10.5603/cj.2020.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Ines Mendes
- Centro Hospitalar de Lisboa Ocidental, Portugal
| | - Rui Anjos
- Centro Hospitalar de Lisboa Ocidental, Portugal
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16
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Rato J, Ataíde R, Martins D, Moldovan O, Cavaco D, Anjos R. Arrhythmogenic right ventricular cardiomyopathy presenting as myocarditis in young patients: a concealed relationship. Rev Esp Cardiol (Engl Ed) 2020; 73:424-426. [PMID: 31753771 DOI: 10.1016/j.rec.2019.10.007] [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] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
- João Rato
- Department of Pediatric Cardiology, Hospital de Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
| | - Rita Ataíde
- Department of Pediatric Cardiology, Hospital de Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Duarte Martins
- Department of Pediatric Cardiology, Hospital de Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Oana Moldovan
- Medical Genetics Service, Pediatric Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Diogo Cavaco
- Department of Cardiology, Hospital de Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Rui Anjos
- Department of Pediatric Cardiology, Hospital de Santa Cruz - Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
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Rato J, Sousa A, Cordeiro S, Mendes M, Anjos R. Sports practice predicts better functional capacity in children and adults with Fontan circulation. Int J Cardiol 2020; 306:67-72. [DOI: 10.1016/j.ijcard.2019.11.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/14/2019] [Accepted: 11/15/2019] [Indexed: 01/09/2023]
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Rato J, Ataíde R, Martins D, Moldovan O, Cavaco D, Anjos R. Miocardiopatía arritmogénica del ventrículo derecho en pacientes jóvenes con miocarditis: una asociación oculta. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ataíde Silva R, Martins D, Teixeira A, Anjos R. Tetralogy of Fallot with absent pulmonary valve: main differences with classic Fallot are crucial for an accurate prenatal diagnosis and counselling. BMJ Case Rep 2020; 13:13/4/e233592. [PMID: 32276999 DOI: 10.1136/bcr-2019-233592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rita Ataíde Silva
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
| | - Duarte Martins
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
| | - Ana Teixeira
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
| | - Rui Anjos
- Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Lisboa, Portugal
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Cordeiro Rato Mesquita Da Silva JP, Martins D, Cordeiro Mendes S, Anjos R. 1167 Atrial strain predicts exercise capacity in patients with the fontan circulation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.670] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Introduction
Atrial function has recently emerged as a valuable parameter, particularly for evaluation of ventricular diastolic dysfunction and heart failure. There is a strong need for reliable echocardiographic predictors of exercise capacity in univentricular hearts, but their particular anatomy makes it challenging. In this work we aimed to characterize the relationship between atrial strain and exercise parameters in the Fontan population.
Methods
Fontan patients followed in our outpatient clinic were prospectively evaluated with cardiopulmonary exercise test and transthoracic echocardiogram. The dominant atrium, i.e. the atrium connected to the dominant atrioventricular valve, was assessed with speckle-tracking echocardiography for active (εact), conduit (εcon), and reservoir (εres) strain; and εact/εres ratio. A single cardiac loop from the 4 chamber view was selected for this analysis and the ‘zero’ strain reference for atrial deformation analysis was set at the onset of the electrocardiogram P wave. Exercise capacity defined as the percentage of peak oxygen uptake (VO2), comparing with predicted values, was chosen as the dependent variable. Independent variables were selected among clinical and echocardiographic data. Statistical analysis was performed using SPSS version 23. T-student test was used for binomial and continuous variable correlation; single and multivariable linear regression was used for continuous variable correlation. Statistical significance was defined as p-value < 0.05.
Results
Fifty-two Fontan patients were assessed. Nineteen (37%) were excluded due to inadequate deformation tracking of the atrial wall. Mean age was 18.0 years (SD 6.9, min. 10.0 - max. 36.0), mean age at Fontan surgery was 7.0 years (SD 2.9, min. 3.0 – max. 18.0). Peak VO2 as a percentage of the predicted value was 66.5% (SD 18.8, min. 36.4 – max. 118.6). εact was -11.1% (SD 3.7, min. -21.1 – max. -4.8), εcon was 10.6% (SD 6.5, min. -0.5 – max. 6.5), εres was 21.7% (SD 5.2, min. 13.2 – max. 34.4) and εact/εres ratio was 0.54 (SD 0.23, min. 0.22 – max. 1.04). On univariate analysis, all atrial strain variables correlated with peak VO2. After adjusting for collinearity, multivariable regression defined age (estimate -1.6, 95% CI: -2.5 to -0.9, p-value < 0.001) and εact strain (estimate 1.8, 95% CI: 0.5 to 3.2, p-value = 0.011) as the strongest predictors of peak VO2 (r2= 0.479).
Conclusion
Peak VO2 defines exercise capacity and is a strong marker of prognosis in Fontan patients. There are very few echocardiographic variables capable of predicting it, in part due to a variable cardiac anatomy. We showed that atrial strain rate is a novel echocardiographic parameter that predicts peak VO2. In the Fontan circulation, a higher reliance on active atrial contraction for ventricular filling predicts lower exercise capacity. Therefore, atrial strain rate, whenever measurable, may provide a new method of risk stratification in this population.
Abstract 1167 Figure. Example of atrial strain curve.
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Affiliation(s)
| | - D Martins
- Hospital Santa Cruz, Lisbon, Portugal
| | | | - R Anjos
- Hospital Santa Cruz, Lisbon, Portugal
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21
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Rato J, R Sousa A, Teixeira A, Anjos R. Ebstein's anomaly with 'reversible' functional pulmonary atresia. BMJ Case Rep 2019; 12:12/12/e229809. [PMID: 31888914 DOI: 10.1136/bcr-2019-229809] [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: 11/04/2022] Open
Abstract
We present the case of an infant with prenatal diagnosis, at 32 weeks gestation, of Ebstein's anomaly without anterograde flow from right ventricular to pulmonary atresia (PA)-functional PA with flow reversal in the ductus arteriosus. Prostaglandin E1 was started after birth. Chest X-ray showed severe cardiomegaly and echocardiogram confirmed Ebstein's anomaly with a thickened non-opening pulmonary valve without anterograde flow but with mild regurgitation. Multidisciplinary team decision was to progressively reduce prostaglandins and have an expectant attitude. Peripheral oxygen saturation above 85% was maintained and serial echocardiograms documented progressive reduction of the ductus arteriosus and the opening of the pulmonic valve cusps, with the development of anterograde flow. The newborn was discharged at day 19 of life without the need for any intervention, and at last follow-up remains asymptomatic, with anterograde normal flow in the pulmonary valve.
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Affiliation(s)
- João Rato
- Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Carnaxide, Lisboa, Portugal
| | - Ana R Sousa
- Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Carnaxide, Lisboa, Portugal
| | - Ana Teixeira
- Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Carnaxide, Lisboa, Portugal
| | - Rui Anjos
- Pediatric Cardiology, Hospital Santa Cruz, Carnaxide, Portugal
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Rato J, Martins D, Mendes IC, Anjos R. A sudden turner of events. J Card Surg 2019; 34:363-366. [PMID: 30932229 DOI: 10.1111/jocs.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 11/30/2022]
Abstract
The authors report the case of an 18-year-old woman with Turner Syndrome and aortic coarctation, who developed aortic dissection after percutaneous stenting. Surgical treatment was necessary as the lesion progressed. This case highlights both the importance of awareness as well as multidisciplinary management of this potential complication.
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Affiliation(s)
- João Rato
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Duarte Martins
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Inês Carmo Mendes
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Rui Anjos
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
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23
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Pars S, Cristo F, Inácio JM, Rosas G, Carreira IM, Melo JB, Mendes P, Martins DS, de Almeida LP, Maio J, Anjos R, Belo JA. Generation and characterization of a human iPS cell line from a patient-related control to study disease mechanisms associated with DAND5 p.R152H alteration. Stem Cell Res 2018; 29:202-206. [PMID: 29730570 DOI: 10.1016/j.scr.2018.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 02/06/2023] Open
Abstract
A DAND5-control human iPSC line was generated from the urinary cells of a phenotypically normal donor. Exfoliated renal epithelial (RE) cells were collected and reprogrammed into iPSCs using Sendai virus reprogramming system. The pluripotency, in vitro differentiation potential, karyotype stability, and the transgene-free status of generated iPSC line were analyzed and confirmed. This cell line can be exploited as a control iPSC line to better understand the mechanisms involved in DAND5-associated cardiac disease.
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Affiliation(s)
- Selin Pars
- Stem Cells and Development Laboratory, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Fernando Cristo
- Stem Cells and Development Laboratory, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - José M Inácio
- Stem Cells and Development Laboratory, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Rosas
- Stem Cells and Development Laboratory, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Isabel Marques Carreira
- Cytogenetics and Genomics Laboratory, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal; CIMAGO - Center of Investigation on Environment Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Portugal
| | - Joana Barbosa Melo
- Cytogenetics and Genomics Laboratory, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal; CIMAGO - Center of Investigation on Environment Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Portugal
| | - Patrícia Mendes
- Departamento Materno-Infantil, Centro Hospital do Algarve, EPE, Faro, Portugal
| | | | | | - José Maio
- Departamento Materno-Infantil, Centro Hospital do Algarve, EPE, Faro, Portugal
| | - Rui Anjos
- Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - José A Belo
- Stem Cells and Development Laboratory, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
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Affiliation(s)
- Ana Coutinho Santos
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Duarte Martins
- Department of Paediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Rui Anjos
- Department of Paediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Carla Saraiva
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
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25
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Affiliation(s)
- Inês C Mendes
- Pediatric Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal.
| | - Ana Rita Araújo
- Pediatric Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Rui Anjos
- Pediatric Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Ana Teixeira
- Pediatric Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal
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26
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Mendes IC, Araújo AR, Anjos R, Teixeira A. Fetal giant cardiac tumor. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2016.09.018] [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: 11/24/2022] Open
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27
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Cristo F, Inácio JM, de Almeida S, Mendes P, Martins DS, Maio J, Anjos R, Belo JA. Functional study of DAND5 variant in patients with Congenital Heart Disease and laterality defects. BMC Med Genet 2017; 18:77. [PMID: 28738792 PMCID: PMC5525210 DOI: 10.1186/s12881-017-0444-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/13/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Perturbations on the Left-Right axis establishment lead to laterality defects, with frequently associated Congenital Heart Diseases (CHDs). Indeed, in the last decade, it has been reported that the etiology of isolated cases of CHDs or cases of laterality defects with associated CHDs is linked with variants of genes involved in the Nodal signaling pathway. METHODS With this in mind, we analyzed a cohort of 38 unrelated patients with Congenital Heart Defects that can arise from initial perturbations in the formation of the Left-Right axis and 40 unrelated ethnically matched healthy individuals as a control population. Genomic DNA was extracted from buccal epithelial cells, and variants screening was performed by PCR and direct sequencing. A Nodal-dependent luciferase assay was conducted in order to determine the functional effect of the variant found. RESULTS In this work, we report two patients with a DAND5 heterozygous non-synonymous variant (c.455G > A) in the functional domain of the DAND5 protein (p.R152H), a master regulator of Nodal signaling. Patient 1 presents left isomerism, ventricular septal defect with overriding aorta and pulmonary atresia, while patient 2 presents ventricular septal defect with overriding aorta, right ventricular hypertrophy and pulmonary atresia (a case of extreme tetralogy of Fallot phenotype). The functional analysis assay showed a significant decrease in the activity of this variant protein when compared to its wild-type counterpart. CONCLUSION Altogether, our results provide new insight into the molecular mechanism of the laterality defects and related CHDs, priming for the first time DAND5 as one of multiple candidate determinants for CHDs in humans.
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Affiliation(s)
- Fernando Cristo
- Stem Cells and Development Laboratory, CEDOC, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Center for Biomedical Research (CBMR), Universidade do Algarve, Faro, Portugal.,Biomedical Sciences, Universidade do Algarve, Faro, Portugal.,Regenerative Medicine Program, Biomedical and Medicine Sciences Department, Universidade do Algarve, Faro, Portugal
| | - José M Inácio
- Stem Cells and Development Laboratory, CEDOC, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Salomé de Almeida
- Medical Genetics Service, Centro Hospitalar Lisboa Central (CHLC), EPE, Lisboa, Portugal
| | - Patrícia Mendes
- Departamento Materno-Infantil, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | | | - José Maio
- Departamento Materno-Infantil, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Rui Anjos
- Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - José A Belo
- Stem Cells and Development Laboratory, CEDOC, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal. .,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Edifício CEDOC II, Rua Câmara Pestana n.° 6, 1150-082, Lisboa, Portugal.
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28
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Costa C, Anjos R, Martins D, Canada M. The role of three-dimensional transesophageal echocardiography in percutaneous closure of atrial septal defects associated with aneurysm of the atrial septum. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2016.04.010] [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: 11/15/2022] Open
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29
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Silva SL, Albuquerque AS, Matoso P, Charmeteau-de-Muylder B, Cheynier R, Ligeiro D, Abecasis M, Anjos R, Barata JT, Victorino RMM, Sousa AE. IL-7-Induced Proliferation of Human Naive CD4 T-Cells Relies on Continued Thymic Activity. Front Immunol 2017; 8:20. [PMID: 28154568 PMCID: PMC5243809 DOI: 10.3389/fimmu.2017.00020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Received: 09/04/2016] [Accepted: 01/05/2017] [Indexed: 01/06/2023] Open
Abstract
Naive CD4 T-cell maintenance is critical for immune competence. We investigated here the fine-tuning of homeostatic mechanisms of the naive compartment to counteract the loss of de novo CD4 T-cell generation. Adults thymectomized in early childhood during corrective cardiac surgery were grouped based on presence or absence of thymopoiesis and compared with age-matched controls. We found that the preservation of the CD31- subset was independent of the thymus and that its size is tightly controlled by peripheral mechanisms, including prolonged cell survival as attested by Bcl-2 levels. Conversely, a significant contraction of the CD31+ naive subset was observed in the absence of thymic activity. This was associated with impaired responses of purified naive CD4 T-cells to IL-7, namely, in vitro proliferation and upregulation of CD31 expression, which likely potentiated the decline in recent thymic emigrants. Additionally, we found no apparent constraint in the differentiation of naive cells into the memory compartment in individuals completely lacking thymic activity despite upregulation of DUSP6, a phosphatase associated with increased TCR threshold. Of note, thymectomized individuals featuring some degree of thymopoiesis were able to preserve the size and diversity of the naive CD4 compartment, further arguing against complete thymectomy in infancy. Overall, our data suggest that robust peripheral mechanisms ensure the homeostasis of CD31- naive CD4 pool and point to the requirement of continuous thymic activity to the maintenance of IL-7-driven homeostatic proliferation of CD31+ naive CD4 T-cells, which is essential to secure T-cell diversity throughout life.
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Affiliation(s)
- Susana L Silva
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal; Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Adriana S Albuquerque
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa , Lisboa , Portugal
| | - Paula Matoso
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa , Lisboa , Portugal
| | - Bénédicte Charmeteau-de-Muylder
- Cytokines and Viral Infections, Immunology Infection and Inflammation Department, Institut Cochin, INSERM, U1016, Paris, France; CNRS, UMR8104, Paris, France; Université Paris Descartes, Paris, France
| | - Rémi Cheynier
- Cytokines and Viral Infections, Immunology Infection and Inflammation Department, Institut Cochin, INSERM, U1016, Paris, France; CNRS, UMR8104, Paris, France; Université Paris Descartes, Paris, France
| | - Dário Ligeiro
- Centro de Sangue e Tranplantação de Lisboa, Instituto Português de Sangue e Transplantação, IP , Lisboa , Portugal
| | - Miguel Abecasis
- Departamento do Coração, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental , Carnaxide , Portugal
| | - Rui Anjos
- Departamento do Coração, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental , Carnaxide , Portugal
| | - João T Barata
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa , Lisboa , Portugal
| | - Rui M M Victorino
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal; Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Ana E Sousa
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa , Lisboa , Portugal
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30
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Ranchordás S, Madeira M, Saraiva Martins D, Marques M, Ferreira A, Menezes I, Anjos R, Abecacis M. Benign Presentation of a Potentially Fatal Disease. Rev Port Cir Cardiotorac Vasc 2017; 24:71-73. [PMID: 29898301] [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] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Indexed: 06/08/2023]
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital cardiovascular defect that can range from being fatal early in life to presenting in adulthood asymptomatically. We report the case of a teenager whose diagnosis was incidental and underwent surgery, consisting in coronary artery button transfer, with excellent result.
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Affiliation(s)
- Sara Ranchordás
- Cardiac surgery, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Márcio Madeira
- Cardiac surgery, Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - Marta Marques
- Cardiac surgery, Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - Isabel Menezes
- Pediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Rui Anjos
- Pediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Miguel Abecacis
- Cardiac surgery, Hospital de Santa Cruz, Carnaxide, Portugal
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31
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Cabral R, Pires R, Anjos R, Branco CC, Maciel P, Mota-Vieira L. Genealogical and molecular analysis of a family-based cohort of congenital heart disease patients from the São Miguel Island (Azores, Portugal). Ann Hum Biol 2016; 43:547-553. [PMID: 26568276 DOI: 10.3109/03014460.2015.1119888] [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: 11/13/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is one common birth malformation, accounting for ∼30% of total congenital abnormalities. AIM Considering the unknown role of consanguinity in causing CHD, this study hypothesised that consanguineous unions and/or familial aggregation may be frequent in the Azorean Island of São Miguel (Portugal). To that end, a retrospective observational study was performed based on genealogical and molecular analyses. SUBJECTS AND METHODS The study enrolled 112 CHD patients from São Miguel Island, which allowed the assessment of type of family (simplex or multiplex), parental consanguinity and grandparental endogamy. Based on 15 STR markers, inbreeding coefficients (FIS) in the CHD cohort and healthy control group (n = 114) were estimated. RESULTS Multiplex families were 37.6% (n = 41/109), a rate considerably higher than previously described in the literature (< 15%). Moreover, 9.2% (n = 10/109) of the CHD families were consanguineous, mostly derived from third cousin unions, and 20.2% (n = 22/109) presented full grandparental endogamy. Higher FIS values were found in patients with parental consanguinity (0.0371) and patent ductus arteriosus (0.0277). CONCLUSION This study analysed several genealogical and genetic features related with CHD, revealing the presence of parental consanguinity and extensive familial aggregation in the CHD patients from São Miguel Island.
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Affiliation(s)
- Rita Cabral
- a Molecular Genetics and Pathology Unit, Hospital of Divino Espírito Santo of Ponta Delgada, EPE , São Miguel Island, Azores , Portugal
| | - Renato Pires
- a Molecular Genetics and Pathology Unit, Hospital of Divino Espírito Santo of Ponta Delgada, EPE , São Miguel Island, Azores , Portugal.,b Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa , Portugal
| | - Rui Anjos
- c Department of Pediatric Cardiology , Hospital of Santa Cruz , Carnaxide , Portugal
| | - Claudia C Branco
- a Molecular Genetics and Pathology Unit, Hospital of Divino Espírito Santo of Ponta Delgada, EPE , São Miguel Island, Azores , Portugal.,b Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa , Portugal.,d Instituto Gulbenkian de Ciência , Oeiras , Portugal , and
| | - Paula Maciel
- e Department of Pediatrics , Hospital of Divino Espírito Santo of Ponta Delgada, EPE , São Miguel Island, Azores , Portugal
| | - Luisa Mota-Vieira
- a Molecular Genetics and Pathology Unit, Hospital of Divino Espírito Santo of Ponta Delgada, EPE , São Miguel Island, Azores , Portugal.,b Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa , Portugal.,d Instituto Gulbenkian de Ciência , Oeiras , Portugal , and
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Abstract
BACKGROUND A 30-year-old female with tricuspid valve atresia, ventricular septal defect, and atrial septal defect had a neonatal modified Blalock Taussig shunt and a Fontan-Björk operation performed at five years of age. She did well initially but progressively developed signs of systemic congestion due to severe homograft stenosis and underwent successful percutaneous implantation of a Melody® pulmonary valve (Medtronic, Minneapolis, MN, USA) in the "tricuspid" position.
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Affiliation(s)
- Inês C Mendes
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Rui Anjos
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Lisbon, Portugal
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Dias FM, Cordeiro S, Menezes I, Nogueira G, Teixeira A, Marques M, Abecasis M, Anjos R. [Congenital Heart Disease in Children with Down Syndrome: What Has Changed in the Last Three Decades?]. ACTA MEDICA PORT 2016; 29:613-620. [PMID: 28103457 DOI: 10.20344/amp.7318] [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: 09/16/2015] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The prevalence of Down syndrome has increased in the last 30 years; 55% of these children have congenital heart disease. MATERIAL AND METHODS A retrospective longitudinal cohort study; clinical data from 1982 to 2013 databases with the diagnosis of Down syndrome or trisomy 21 in a reference hospital in pediatric cardiology and cardiac surgery. OBJECTIVE to assess the progress in the last three decades of cardiological care given to children with Down syndrome and congenital heart disease. RESULTS We studied 102 patients with Down syndrome and congenital heart disease subjected to invasive therapy: corrective or palliative cardiac surgery and therapeutic catheterization. The referral age was progressively earlier in patients referred in the first year of life. The most frequent diagnosis was complete atrioventricular sptal defect (41%). There was a trend towards increasingly early corrective surgery in patients under 12 months (p < 0.001). Since 2000, the large majority of patients were operated before reaching six months of age. The main cardiac complications were rhythm dysfunction and low output. More frequent noncardiac complications were pulmonary and infectious. The 30-day mortality rate was 3/102 cases (2.9%). Of patients in follow-up, 89% are in NYHA class I. DISCUSSION AND CONCLUSION The early surgical correction seen over the past 15 years follows the approach suggested in the literature. The observed 30-day mortality rate is overlapping international results. Patients with Down syndrome subjected to corrective surgery of congenital heart disease have an excellent long-term functional capacity.
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Affiliation(s)
- Filipa Mestre Dias
- Serviço de Pediatria. Unidade de Faro. Centro Hospitalar do Algarve. Faro. Portugal
| | - Susana Cordeiro
- Serviço de Cardiologia Pediátrica. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Isabel Menezes
- Serviço de Cardiologia Pediátrica. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Graça Nogueira
- Serviço de Cardiologia Pediátrica. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Ana Teixeira
- Serviço de Cardiologia Pediátrica. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Marta Marques
- Serviço de Cirurgia Cardiotorácica. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Miguel Abecasis
- Serviço de Cirurgia Cardiotorácica. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Rui Anjos
- Serviço de Cardiologia Pediátrica. Hospital de Santa Cruz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
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Crisóstomo S, Cardigos J, Costa L, Basílio A, Anjos R, Cardoso M, Gomes T. Ab Interno Collagen Stent implantation as a treatment option for open angle glaucoma. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Costa L, Cardigos J, Crisostomo S, Anjos R, Sa Cardoso M, Gomes T. Macroscopic analysis of filtering bleb functionality after XEN Gel Stent implantation with Anterior Segment Optical Coherence Tomography. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0638] [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: 11/30/2022]
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36
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Cardigos J, Crisostomo S, Costa L, Anjos R, Vieira L, Cardoso M, Reina M, Gomes T. Filtering blebs after XEN implantation and trabeculectomy: a clinical and in vivo
confocal microscopy study. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0473] [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: 11/29/2022]
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37
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Araújo Silva AR, Carmo Mendes I, Cordeiro S, Anjos R. Severe left ventricular outflow tract obstruction. Rev Port Cardiol 2016; 35:383-4. [DOI: 10.1016/j.repc.2015.08.004] [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] [Received: 08/14/2015] [Accepted: 08/24/2015] [Indexed: 10/21/2022] Open
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38
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Araújo Silva AR, Carmo Mendes I, Cordeiro S, Anjos R. Severe left ventricular outflow tract obstruction. Revista Portuguesa de Cardiologia (English Edition) 2016. [DOI: 10.1016/j.repce.2015.08.015] [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: 11/28/2022] Open
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39
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Araújo AR, Marçal M, Tuna M, Anjos R. Cardiac dysfunction and prenatal exposure to venlafaxine. Clin Case Rep 2016; 4:383-6. [PMID: 27099733 PMCID: PMC4831389 DOI: 10.1002/ccr3.412] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/22/2015] [Accepted: 09/10/2015] [Indexed: 11/07/2022] Open
Abstract
Venlofaxine, a widely used antidepressant, is known to cause a withdrawal syndrome. We present a case of neonatal transient ventricular dysfunction in a neonate exposed to venlafaxine in utero. Other causes of ventricular dysfunction were excluded. Neonatal ventricular dysfunction can be a possible side effect of maternal use of this drug.
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Affiliation(s)
- Ana R Araújo
- Pediatric Cardiology DepartmentHospital de Santa CruzCentro Hospitalar de Lisboa OcidentalLisboaPortugal
| | - Mónica Marçal
- Neonatal Intensive Care UnitHospital de São Francisco XavierCentro Hospitalar de Lisboa OcidentalLisboaPortugal
| | - Madalena Tuna
- Neonatal Intensive Care UnitHospital de São Francisco XavierCentro Hospitalar de Lisboa OcidentalLisboaPortugal
| | - Rui Anjos
- Pediatric Cardiology DepartmentHospital de Santa CruzCentro Hospitalar de Lisboa OcidentalLisboaPortugal
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40
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Morgado J, Sanches B, Anjos R, Coelho C. Programming of Essential Hypertension: What Pediatric Cardiologists Need to Know. Pediatr Cardiol 2015; 36:1327-37. [PMID: 26015087 DOI: 10.1007/s00246-015-1204-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/14/2015] [Indexed: 01/11/2023]
Abstract
Hypertension is recognized as one of the major contributing factors to cardiovascular disease, but its etiology remains incompletely understood. Known genetic and environmental influences can only explain a small part of the variability in cardiovascular disease risk. The missing heritability is currently one of the most important challenges in blood pressure and hypertension genetics. Recently, some promising approaches have emerged that move beyond the DNA sequence and focus on identification of blood pressure genes regulated by epigenetic mechanisms such as DNA methylation, histone modification and microRNAs. This review summarizes information on gene-environmental interactions that lead toward the developmental programming of hypertension with specific reference to epigenetics and provides pediatricians and pediatric cardiologists with a more complete understanding of its pathogenesis.
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Affiliation(s)
- Joana Morgado
- Pediatrics Department, Hospital do Espírito Santo de Évora, Largo Senhor da Pobreza, 7000-811, Évora, Portugal.
| | - Bruno Sanches
- Pediatrics Department, Hospital Garcia de Orta, Almada, Portugal
| | - Rui Anjos
- Pediatric Cardiology Department, Hospital Santa Cruz, Lisbon, Portugal
| | - Constança Coelho
- Genetics Laboratory, Environmental Health Institute, Lisbon Medical School, Lisbon, Portugal
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41
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Costa L, Vicente A, Anjos R, Santos A, Ferreira J, Amado D, Cunha J. Optic coherence tomography in analyzes of optic nerve and macula in neuro-ophthalmological patients. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0491] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L. Costa
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - A. Vicente
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - R. Anjos
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - A. Santos
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - J. Ferreira
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - D. Amado
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - J.P. Cunha
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
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42
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Cunha J, Proença R, Dias-Santos A, Vicente A, Anjos R, Costa L, Cardigos J, Ferreira J, Amado D. Homonymous hemimacular thinning in retrochiasmal lesions. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0689] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J.P. Cunha
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
| | - R. Proença
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
| | - A. Dias-Santos
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
| | - A. Vicente
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
| | - R. Anjos
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
| | - L. Costa
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
| | - J. Cardigos
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
| | - J. Ferreira
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
| | - D. Amado
- Centro Hospitalar de Lisboa Central; Oftalmologia; Lisboa Portugal
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43
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Cunha J, Proença R, Dias-Santos A, Vicente A, Anjos R, Costa L, Cardigos J, Ferreira J, Amado D. Homonymous hemimacular thinning in retrochiasmal lesions. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.1689] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J.P. Cunha
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - R. Proença
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - A. Dias-Santos
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - A. Vicente
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - R. Anjos
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - L. Costa
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - J. Cardigos
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - J. Ferreira
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - D. Amado
- Oftalmologia; Centro Hospitalar de Lisboa Central; Lisboa Portugal
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Madeira S, Raposo L, David R, Marques A, Andrade Gomes J, Cardim N, Anjos R. Dyspnea in a nonagenarian: The usual suspects, an unexpected culprit. Revista Portuguesa de Cardiologia (English Edition) 2015. [DOI: 10.1016/j.repce.2015.08.009] [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: 11/15/2022] Open
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45
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Madeira S, Raposo L, David R, Marques A, Andrade Gomes J, Cardim N, Anjos R. Dyspnea in a nonagenarian: The usual suspects, an unexpected culprit. Rev Port Cardiol 2015; 34:559.e1-6. [PMID: 26320092 DOI: 10.1016/j.repc.2015.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 01/02/2015] [Indexed: 11/15/2022] Open
Abstract
Platypnea-orthodeoxia syndrome (POS) is an uncommon syndrome characterized by dyspnea and hypoxemia triggered by orthostatism and relieved by recumbency. It is often associated with an interatrial shunt through a patent foramen ovale (PFO). We report the case of a 92-year-old woman initially admitted in the setting of a traumatic femoral neck fracture (successfully treated with hip replacement surgery) in whom a reversible decline in transcutaneous oxygen saturation from 98% (in the supine position) to 84% (in the upright position) was noted early post-operatively. Thoracic multislice computed tomography excluded pulmonary embolism and severe parenchymal lung disease. The diagnosis of POS was confirmed by tilt-table contrast transesophageal echocardiography, which demonstrated a dynamic and position-dependent right-to-left shunt (torrential when semi-upright and minimal in the supine position) through a PFO. The patient underwent percutaneous closure of the PFO with an Amplatzer device, which led to prompt symptom relief and full functional recovery.
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Affiliation(s)
| | | | | | | | | | | | - Rui Anjos
- Hospital de Santa Cruz, Carnaxide, Portugal
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46
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Vaz SO, Pires R, Pires LM, Carreira IM, Anjos R, Maciel P, Mota-Vieira L. A unique phenotype in a patient with a rare triplication of the 22q11.2 region and new clinical insights of the 22q11.2 microduplication syndrome: a report of two cases. BMC Pediatr 2015; 15:95. [PMID: 26297018 PMCID: PMC4546098 DOI: 10.1186/s12887-015-0417-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 08/13/2015] [Indexed: 11/24/2022] Open
Abstract
Background The rearrangements of the 22q11.2 chromosomal region, most frequently deletions and duplications, have been known to be responsible for multiple congenital anomaly disorders. These rearrangements are implicated in syndromes that have some phenotypic resemblances. While the 22q11.2 deletion, also known as DiGeorge/Velocardiofacial syndrome, has common features that include cardiac abnormalities, thymic hypoplasia, characteristic face, hypocalcemia, cognitive delay, palatal defects, velopharyngeal insufficiency, and other malformations, the microduplication syndrome is largely undetected. This is mainly because phenotypic appearance is variable, milder, less characteristic and unpredictable. In this paper, we report the clinical evaluation and follow-up of two patients affected by 22q11.2 rearrangements, emphasizing new phenotypic features associated with duplication and triplication of this genomic region. Case Presentation Patient 1 is a 24 year-old female with 22q11.2 duplication who has a heart defect (ostium secundum atrial septal defect) and supernumerary teeth (hyperdontia), a feature previously not reported in patients with 22q11.2 microduplication syndrome. Her monozygotic twin sister, who died at the age of one month, had a different heart defect (truncus arteriousus). Patient 2 is a 20 year-old female with a 22q11.2 triplication who had a father with 22q11.2 duplication. In comparison to the first case reported in the literature, she has an aggravated phenotype characterized by heart defects (restrictive VSD and membranous subaortic stenosis), and presented other facial dysmorphisms and urogenital malformations (ovarian cyst). Additionally, she has a hemangioma planum on the right side of her face, a feature of Sturge-Weber syndrome. Conclusions In this report, we described hyperdontia as a new feature of 22q11.2 microdeletion syndrome. Moreover, this syndrome was diagnosed in a patient who had a deceased monozygotic twin affected with a different heart defect, which corresponds to a phenotypic discordance never reported in the literature. Case 2 is the second clinical report of 22q11.2 triplication and presents an aggravated phenotype in contrast to the patient previously reported.
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Affiliation(s)
- Sara O Vaz
- Department of Pediatrics of Hospital of Divino Espírito Santo of Ponta Delgada, EPE, Av. D. Manuel I, 9500-370, Ponta Delgada, São Miguel Island, Azores, Portugal.
| | - Renato Pires
- Molecular Genetics and Pathology Unit, Hospital of Divino Espírito Santo of Ponta Delgada, EPE, Av. D. Manuel I, 9500-370, Ponta Delgada, São Miguel Island, Azores, Portugal. .,Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa, 1749-016, Lisboa, Portugal.
| | - Luís M Pires
- Cytogenetics and Genomics Laboratory, Faculty of Medicine, University of Coimbra, 3000-354, Coimbra, Portugal.
| | - Isabel M Carreira
- Cytogenetics and Genomics Laboratory, Faculty of Medicine, University of Coimbra, 3000-354, Coimbra, Portugal. .,Centro de Investigação em Meio Ambiente, Genética e Oncobiologia (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-354, Coimbra, Portugal. .,Centre of Neurosciences (CNC), University of Coimbra, 3000-354, Coimbra, Portugal.
| | - Rui Anjos
- Department of Pediatric Cardiology, Hospital of Santa Cruz, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.
| | - Paula Maciel
- Department of Pediatrics of Hospital of Divino Espírito Santo of Ponta Delgada, EPE, Av. D. Manuel I, 9500-370, Ponta Delgada, São Miguel Island, Azores, Portugal.
| | - Luisa Mota-Vieira
- Molecular Genetics and Pathology Unit, Hospital of Divino Espírito Santo of Ponta Delgada, EPE, Av. D. Manuel I, 9500-370, Ponta Delgada, São Miguel Island, Azores, Portugal. .,Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa, 1749-016, Lisboa, Portugal. .,Instituto Gulbenkian de Ciência, Rua da Quinta Grande, 6, 2780-156, Oeiras, Portugal.
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Silva D, Martins FM, Cavaco D, Adragão P, Silva MM, Anjos R, Ferreira Á, Gaspar IM. Natural history of Brugada syndrome in a patient with congenital heart disease. Rev Port Cardiol 2015; 34:493.e1-4. [PMID: 26148667 DOI: 10.1016/j.repc.2014.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 10/15/2014] [Accepted: 12/30/2014] [Indexed: 11/19/2022] Open
Abstract
Risk stratification of sudden death in patients with Brugada syndrome (BrS) is a controversial issue, and there is currently no consensus on the best method. Examination of data from the natural history of the disease is of fundamental importance and may help to identify relatives at risk. At the same time, study of the genetic mutations responsible for the disease may also contribute to risk stratification of the syndrome, enabling identification of asymptomatic relatives carrying mutations. This paper presents the case of a young man, aged 26, monitored as a pediatric cardiology outpatient from birth for a simple structural heart defect not requiring surgery. Analysis of the evolution of the patient's electrocardiogram revealed the appearance, at the age of 20, of a pattern compatible with type I BrS. Following an episode of syncope and induction of polymorphic ventricular tachycardia in the electrophysiological study, a cardioverter-defibrillator was implanted. One year later, a single shock terminated an episode of ventricular fibrillation. A molecular study of the SCN5A gene identified a rare mutation, c.3622G>T (p.Glu1208X), recently described and associated with more severe phenotypes in patients with BrS, as in the case presented.
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Affiliation(s)
- Doroteia Silva
- Serviço de Cardiologia I, Hospital Universitário de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
| | - Fernando Maymone Martins
- Serviço de Cardiologia Pediátrica, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Diogo Cavaco
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Pedro Adragão
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Margarida Matos Silva
- Serviço de Cardiologia Pediátrica, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Rui Anjos
- Serviço de Cardiologia Pediátrica, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - Álvaro Ferreira
- Serviço de Neuro-Psicologia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Isabel Mendes Gaspar
- Cardiogenética, Serviço de Cardiologia Pediátrica, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
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48
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Silva D, Maymone Martins F, Cavaco D, Adragão P, Matos Silva M, Anjos R, Ferreira Á, Mendes Gaspar I. Natural history of Brugada syndrome in a patient with congenital heart disease. Revista Portuguesa de Cardiologia (English Edition) 2015. [DOI: 10.1016/j.repce.2015.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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49
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Abstract
Infectious complications represent an important cause of morbidity and death in patients with transplant. Parasitic infections are less frequent than viral and bacterial agents, and are often overlooked. We describe the case of a 13-year-old adolescent, born in São Tomé Island, who was under immunosuppressive therapy after a cardiac transplant. The patient had an intermittent course of diarrhoea, abdominal pain and vomiting. She was admitted dehydrated, and Strongyloides stercoralis, Schistosoma intercalatum and Cystoisospora belli were isolated in her stools. The patient was treated with ivermectin, albendazole, praziquantel and ciprofloxacin with clinical and microbiological resolution. Her immunosuppressive therapy was reduced during hospitalisation. We believe that the parasitic infection was a result of a recrudescence of dormant infections acquired in her homeland. To the best of our knowledge, there are no reports of cystoisosporiasis or schistosomiasis in heart transplant recipients.
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Affiliation(s)
| | - Joana Morgado
- Department of Pediatrics, Hospital Espírito Santo, Évora, Portugal
| | - Nuno Carvalho
- Department of Pediatric Cardiology, Hospital Santa Cruz, Lisbon, Portugal
| | - Rui Anjos
- Department of Pediatric Cardiology, Hospital Santa Cruz, Lisbon, Portugal
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Marcos SP, Castro T, Salazar A, Anjos R. Polymalformative syndrome with congenital heart defect. Einstein (São Paulo) 2015; 13:336-7. [PMID: 26061079 PMCID: PMC4943834 DOI: 10.1590/s1679-45082015ai2900] [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: 08/05/2013] [Accepted: 03/11/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | - Rui Anjos
- Centro Hospitalar Lisboa Ocidental, Portugal
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