1
|
Aiello VD. Has the Natural History of Primary Heart Tumors in Children Been Modified Recently? Arq Bras Cardiol 2024; 121:e20230849. [PMID: 38511809 DOI: 10.36660/abc.20230849] [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: 12/07/2023] [Accepted: 01/18/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Vera Demarchi Aiello
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| |
Collapse
|
2
|
Luzuriaga GDCJ, Dias RR, Santiago JAD, Madrini V, Ishikawa WY, Fernandes F, Aiello VD. Rare association between giant-cell aortitis and giant-cell aortic valvulitis. Autops Case Rep 2023; 13:e2023449. [PMID: 38034520 PMCID: PMC10688263 DOI: 10.4322/acr.2023.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/24/2023] [Indexed: 12/02/2023]
Abstract
Giant cell arteritis (GCA) is a type of chronic vasculitis that affects medium and large-caliber arteries, frequently related to aortic involvement and, consequently, to aneurysm formation. However, associated valvulitis with giant cells is uncommon. We describe the case of a 50-year-old female patient with aortic aneurysm and valvular insufficiency, whose anatomopathological examination revealed giant-cell aortic valvulitis associated with giant cell aortitis.
Collapse
Affiliation(s)
- Georgina del Cisne Jadán Luzuriaga
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Miocardiopatias e Doenças da Aorta, São Paulo, SP, Brasil
| | - Ricardo Ribeiro Dias
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Cirurgia Cardiovascular, São Paulo, SP, Brasil
| | - José Augusto Duncan Santiago
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Cirurgia Cardiovascular, São Paulo, SP, Brasil
| | - Vagner Madrini
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Miocardiopatias e Doenças da Aorta, São Paulo, SP, Brasil
| | - Walther Yoshiharu Ishikawa
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Imagem Cardiovascular, São Paulo, SP, Brasil
| | - Fabio Fernandes
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Miocardiopatias e Doenças da Aorta, São Paulo, SP, Brasil
| | - Vera Demarchi Aiello
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Departamento de Anatomia Patológica, São Paulo, SP, Brasil
| |
Collapse
|
3
|
Giugni FR, Aiello VD, Faria CS, Pour SZ, Cunha MDP, Giugni MV, Pinesi HT, Ledesma FL, Morais CE, Ho YL, Sztajnbok J, de Morais Fernezlian S, Ferraz da Silva LF, Mauad T, Ferreira Alves VA, Hilário do Nascimento Saldiva P, Antonangelo L, Dolhnikoff M, Duarte-Neto AN. Understanding yellow fever-associated myocardial injury: an autopsy study. EBioMedicine 2023; 96:104810. [PMID: 37757571 PMCID: PMC10550587 DOI: 10.1016/j.ebiom.2023.104810] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Yellow fever (YF) is a viral hemorrhagic fever, endemic in parts of South America and Africa. There is scarce evidence about the pathogenesis of the myocardial injury. The objective of this study is to evaluate the cardiac pathology in fatal cases of YF. METHODS This retrospective autopsy study included cases from the São Paulo (Brazil) epidemic of 2017-2019. We reviewed medical records and performed cardiac tissue histopathological evaluation, electron microscopy, immunohistochemical assays, RT-qPCR for YF virus (YFV)-RNA, and proteomics analysis on inflammatory and endothelial biomarkers. FINDINGS Seventy-three confirmed YF cases with a median age of 48 (34-60) years were included. We observed myocardial fibrosis in 68 (93.2%) patients; cardiomyocyte hypertrophy in 68 (93.2%); endothelial alterations in 67 (91.8%); fiber necrosis in 50 (68.5%); viral myocarditis in 9 (12.3%); and secondary myocarditis in 5 (6.8%). Four out of five patients with 17DD vaccine-associated viscerotropic disease presented with myocarditis. The cardiac conduction system showed edema, hemorrhages and endothelial fibrinoid necrosis. Immunohistochemistry detected CD68-positive inflammatory interstitial cells and YFV antigens in endothelial and inflammatory cells. YFV-RNA was detected positive in 95.7% of the cardiac samples. The proteomics analysis demonstrated that YF patients had higher levels of multiple inflammatory and endothelial biomarkers in comparison to cardiovascular controls, and higher levels of interferon gamma-induced protein 10 (IP-10) in comparison to sepsis (p = 0.01) and cardiovascular controls (p < 0.001) in Dunn test. INTERPRETATION Myocardial injury is frequent in severe YF, due to multifactorial mechanisms, including direct YFV-mediated damage, endothelial cell injury, and inflammatory response, with a possible prominent role for IP-10. FUNDING This study was funded by Fundação de Amparo à Pesquisa do Estado de São Paulo, Bill and Melinda Gates Foundation, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.
Collapse
Affiliation(s)
- Fernando Rabioglio Giugni
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Caroline Silverio Faria
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Shahab Zaki Pour
- Laboratório de Evolução Molecular e Bioinformática, Instituto de Ciências Biomédicas, Universidade de São Paulo, SP, Brazil
| | - Marielton Dos Passos Cunha
- Laboratório de Evolução Molecular e Bioinformática, Instituto de Ciências Biomédicas, Universidade de São Paulo, SP, Brazil
| | - Melina Valdo Giugni
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Henrique Trombini Pinesi
- Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Felipe Lourenço Ledesma
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carolina Esteves Morais
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Yeh-Li Ho
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Serviço de Verificação de Óbitos da Capital (SVOC), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Leila Antonangelo
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| |
Collapse
|
4
|
Soares BM, Soares AM, Aiello VD. Superior caval vein syndrome and cardiac inflammatory myofibroblastic tumour in an infant. Cardiol Young 2023; 33:1226-1228. [PMID: 37070343 DOI: 10.1017/s1047951122003845] [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] [Indexed: 04/19/2023]
Abstract
The inflammatory myofibroblastic tumour, although very rare, must be considered in the differential diagnosis of intracardiac masses in children as it has systemic implications. We present a case of an infant whose diagnosis was suspected on clinical basis and echocardiogram, but the anatomopathological analysis with immunohistochemical study was essential for the conclusion of the histological type and orientation of the clinical follow-up.
Collapse
Affiliation(s)
- Bernardo Mussi Soares
- Fundacao Tecnico-Educacional Souza Marques Escola de Medicina Souza Marques, Rio de Janeiro 21310-310, Brazil
| | | | - Vera Demarchi Aiello
- Laboratory of Pathology, Heart Institute (InCor), University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| |
Collapse
|
5
|
Pegado HM, Siqueira A, Navarajasegaran J, Benvenuti LA, Castro CRP, Arrieta SR, Gutierrez PS, Dolhnikoff M, Aiello VD, Jatene MB, Azeka E. Case Report: The Challenge for Diagnosis of Myocarditis and Transplant Rejection After COVID Infection in a Heart-Transplanted Adolescent. Transplant Proc 2023; 55:1449-1450. [PMID: 37516626 DOI: 10.1016/j.transproceed.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/31/2023]
Abstract
Patients who have undergone organ transplantation are immunosuppressed hosts, leaving them at a higher risk of infections. SARS-COV-2 has been shown to affect heart-transplanted patients. In this case report, we present the case of a 14-year-old heart transplant recipient who developed signs and symptoms of heart failure, along with fatigue, after a COVID-19 infection. An endomyocardial biopsy was performed to diagnose rejection and to evaluate whether this was myocarditis due to SARS-COV-2. The biopsy showed intense acute cellular rejection (3R) and antibody rejection PAMR1 H+ but was negative for the SARS-CoV-2 virus. The patient received organ rejection therapy with high-dose methylprednisolone and human immunoglobulin. After treatment, her heart function recovered, with biopsy investigations showing a lower level of cellular rejection (1R).
Collapse
Affiliation(s)
- Helio Milani Pegado
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | - Adailson Siqueira
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | | | - Luiz Alberto Benvenuti
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | | | - Santiago Raul Arrieta
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | | | - Marisa Dolhnikoff
- Pathology Department, University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | - Vera Demarchi Aiello
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | | | - Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil.
| |
Collapse
|
6
|
Fernandes AL, Dinato FJ, Veronese ET, de Almeida Brandão CM, Aiello VD, Jatene FB. Partial pericardiectomy for refractory acute tuberculous pericarditis: A case report. Int J Surg Case Rep 2023; 106:108239. [PMID: 37087940 PMCID: PMC10149216 DOI: 10.1016/j.ijscr.2023.108239] [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: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Tuberculosis is an infectious disease that usually manifests in the lungs but can also affect other organs, including the cardiovascular system. In this article, we present a rare case of purulent pericarditis caused by Mycobacterium tuberculosis. PRESENTATION OF CASE A 67-year-old man was admitted to the emergency department with a large pericardial effusion with evidence of cardiac tamponade caused by acute pericarditis. The patient underwent surgical pericardial drainage, and a total volume of 500 mL of purulent fluid was collected with a positive culture for Mycobacterium tuberculosis. Despite antituberculous drugs, the patient presented with clinical worsening and recurrence of large pericardial effusion. Therefore, he was submitted to a second intervention by full median sternotomy to drain the pericardial effusion and perform a surgical pericardial debridement associated with a partial pericardiectomy. After the procedure, he improved clinically and was discharged after 24 days of hospitalization. DISCUSSION Pericardiectomy is recommended for patients with refractory tuberculous pericarditis after four to eight weeks of antituberculous treatment. We decided not to wait that long to perform an open surgical partial pericardiectomy and debridement with a median sternotomy approach. We believe that this more aggressive surgical approach would be more efficient to combat the infection, which was causing progressive deterioration of patient's clinical condition and early recurrence of significant pericardial effusion. CONCLUSION Open partial pericardiectomy with surgical debridement could be an efficient approach for treatment of a refractory acute tuberculous pericarditis.
Collapse
Affiliation(s)
- André Loureiro Fernandes
- Division of Cardiovascular Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Fabrício José Dinato
- Division of Cardiovascular Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
| | - Elinthon Tavares Veronese
- Division of Cardiovascular Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Vera Demarchi Aiello
- Department of Pathology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Fabio Biscegli Jatene
- Division of Cardiovascular Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
7
|
Aiello VD, Assad RS. When the description of physiology adds to the morphological diagnosis and guides the analysis of clinical and surgical management. J Card Surg 2022; 37:2835-2836. [PMID: 35710975 DOI: 10.1111/jocs.16689] [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] [Received: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Vera Demarchi Aiello
- Laboratory of Pathology, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Renato Samy Assad
- Division of Cardiac Surgery, Heart Institute (InCor), University of São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Honjo RS, Monteleone VF, Aiello VD, Wagenfuhr J, Issa VS, Pomerantzeff PMA, Furusawa EA, Zanardo EA, Kulikowski LD, Bertola DR, Kim CA. Cardiovascular findings in Williams-Beuren Syndrome: Experience of a single center with 127 cases. Am J Med Genet A 2021; 188:676-682. [PMID: 34713566 DOI: 10.1002/ajmg.a.62542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022]
Abstract
Williams-Beuren syndrome (WBS) is a rare, microdeletion syndrome characterized by facial dysmorphisms, intellectual disability, a friendly personality, cardiovascular and other abnormalities. Cardiovascular defects (CVD) are among the most prevalent characteristics in WBS, being supravalvular aortic stenosis (SVAS) the most frequent, followed by peripheral pulmonary stenosis (PPS). A comprehensive retrospective review of medical records of 127 patients with molecular diagnosis of WBS, in a period of 20 years, was done to evaluate the incidence, the natural history of cardiovascular disease, and the need for surgical intervention, including heart transplantation (HT). A total of 94/127 patients presented with CVD. Of these 94 patients, 50% presented with SVAS and 22.3% needed heart surgery and/or cardiac catheterization including one that required HT due to severe SVAS-related heart failure at 19 years of age. The patient died in the postoperative period due to infectious complications. Cardiovascular problems are the major cause of sudden death in patients with WBS, who have a significantly higher mortality risk associated with surgical interventions. There is a higher risk for anesthesia-related adverse events and for major adverse cardiac events following surgery. End-stage heart failure due to myocardial ischemia has been described in WBS patients and it is important to consider that HT can become their only viable option. To our knowledge, the case mentioned here is the first HT reported in an adolescent with WBS. HT can be a viable therapeutic option in WBS patients with adequate evaluation, planning, and a multidisciplinary team to provide the required perioperative care and follow-up.
Collapse
Affiliation(s)
- Rachel Sayuri Honjo
- Genetics Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vanessa Figueiredo Monteleone
- Genetics Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vera Demarchi Aiello
- Pathology Laboratory, Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jaqueline Wagenfuhr
- Pediatric Cardiology Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Heart Transplantation Unit, Instituto do Coraçao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Erika Arai Furusawa
- Pediatric Nephrology Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Evelin Aline Zanardo
- Cytogenomic Laboratory, LIM 03, Pathology Department, Faculdade de Medicina HC-FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leslie Domenici Kulikowski
- Cytogenomic Laboratory, LIM 03, Pathology Department, Faculdade de Medicina HC-FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Debora Romeo Bertola
- Genetics Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Chong Ae Kim
- Genetics Unit, Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
9
|
Lino AMM, Castelli JB, Szor RS, Fernandes F, Aiello VD. Diagnostic challenges in systemic amyloidosis: a case report with clinical and laboratorial pitfalls. Autops Case Rep 2021; 11:e2021326. [PMID: 34631606 PMCID: PMC8489187 DOI: 10.4322/acr.2021.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/22/2021] [Indexed: 12/02/2022] Open
Abstract
Currently, there is growing evidence in the literature warning of misdiagnosis involving amyloidosis and chronic inflammatory demyelinating polyneuropathy (CIDP). Although inducing clinical manifestations outside the peripheral nervous system, light chain and transthyretin amyloidosis may initially present with peripheral neuropathy, which can be indistinguishable from CIDP, leading to a delay in the correct diagnosis. Besides, the precise identification of the amyloid subtype is often challenging. This case report exemplifies clinical and laboratory pitfalls in diagnosing amyloidosis and subtyping amyloid, exposing the patient to potentially harmful procedures.
Collapse
Affiliation(s)
- Angelina Maria Martins Lino
- Universidade de São Paulo (USP), Hospital das Clínicas, Department of Neurology, Clinical Peripheral Nerve Group, São Paulo, SP, Brasil
| | - Jussara Bianchi Castelli
- Universidade de São Paulo (USP), Instituto do Coração, Laboratory of Pathology, São Paulo, SP, Brasil.,Grupo Fleury, Department of Pathology, São Paulo, SP, Brasil
| | - Roberta Shcolnik Szor
- Universidade de São Paulo (USP), Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Fabio Fernandes
- Universidade de São Paulo (USP), Instituto do Coração, Cardiomiopathy Group, São Paulo, SP, Brasil
| | - Vera Demarchi Aiello
- Universidade de São Paulo (USP), Instituto do Coração, Laboratory of Pathology, São Paulo, SP, Brasil
| |
Collapse
|
10
|
Aiello VD, Mattos SDS. The Congenital Heart Disease Diagnosis List for the eleventh iteration of the International Classification of Diseases (ICD11): Translation to Brazilian Portuguese. Arq Bras Cardiol 2021; 117:558-560. [PMID: 34550243 PMCID: PMC8462966 DOI: 10.36660/abc.20210143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Vera Demarchi Aiello
- Laboratório de Anatomia Patológica, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | | |
Collapse
|
11
|
Vieira MLC, Branco CEDB, Gazola ASL, Vieira PPAC, Benvenuti LA, Demarchi LMMF, Gutierrez PS, Aiello VD, Tarasoutchi F, Sampaio RO. 3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time. Front Cardiovasc Med 2021; 8:676938. [PMID: 34355026 PMCID: PMC8329529 DOI: 10.3389/fcvm.2021.676938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease (RHD) remains to be a very important health issue worldwide, mainly in underdeveloped countries. It continues to be a leading cause of morbidity and mortality throughout developing countries. RHD is a delayed non-suppurative immunologically mediated inflammatory response to the throat infection caused by a hemolytic streptococcus from the A group (Streptococcus pyogenes). RHD keeps position 1 as the most common cardiovascular disease in young people aged <25 years considering all the continents. The disease can lead to valvular cardiac lesions as well as to carditis. Rheumatic fever valvular injuries lead most commonly to the fusion and thickening of the edges of the cusps and to the fusion, thickening, and shortening of the chordae and ultimately to calcification of the valves. Valvular commissures can also be deeply compromised, leading to severe stenosis. Atrial and ventricular remodeling is also common following rheumatic infection. Mixed valvular lesions are more common than isolated valvular disorders. Echocardiography is the most relevant imaging technique not only to provide diagnostic information but also to enable prognostic data. Further, it presents a very important role for the correction of complications after surgical repair of rheumatic heart valvulopathies. Three-dimensional (3D) echocardiography provides additional anatomical and morphofunctional information of utmost importance for patients presenting rheumatic valvopathies. Accordingly, three-dimensional echocardiography is ready for routine use in patients with RHD presenting with valvular abnormalities.
Collapse
Affiliation(s)
- Marcelo Luiz Campos Vieira
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Flávio Tarasoutchi
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| |
Collapse
|
12
|
Dos Reis FP, Campos SV, Aiello VD, Duarte MIS, Samano MN, Pego-Fernandes PM. Corrigendum to "Gastrointestinal mucormycosis post lung transplantation" [Braz J Infect Dis 23 (2019) 368-370]. Braz J Infect Dis 2020; 24:92. [PMID: 31904349 DOI: 10.1016/j.bjid.2019.12.006] [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: 10/25/2022] Open
Affiliation(s)
- Flavio Pola Dos Reis
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, São Paulo, SP, Brazil.
| | - Silvia Vidal Campos
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, São Paulo, SP, Brazil
| | - Maria Irma Seixas Duarte
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, São Paulo, SP, Brazil
| | - Marcos Naoyuki Samano
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, São Paulo, SP, Brazil
| | | |
Collapse
|
13
|
Aiello VD, Tanigawa RY, Chate RC, de Campos FPF, Mansur AJ. Progressive dyspnea and a right atrial mass in an 80-year-old man. Autops Case Rep 2019; 9:e2019135. [PMID: 31807438 PMCID: PMC6880769 DOI: 10.4322/acr.2019.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is among the five most frequent causes of cancer death worldwide, according to the WHO. The disease is related to alcohol abuse, viral infections, and other causes of cirrhosis, and unfortunately, in some developed countries, the incidence shows an increasing trend. Although the diagnosis of the HCC often relies upon the context of a chronic hepatopathy, some cases may present a silent course, and the initial symptoms ensue when the disease is in an advanced stage with no chance for any therapeutic attempt. The clinical picture of the HCC is varied, and unexpected forms may surprise the clinician. One of the unusual presentations of the HCC is shock by the blockage of the venous return to the right atrium by the inferior vena cava infiltration. Herein we present a case of an old patient who sought medical care complaining of dyspnea. The clinical workup disclosed a right thorax pleural effusion and imaging exams depicted a mass in the right hepatic lobe, invasion of the inferior vena cava (IVC) and the right atrium (RA). During the attempts of clinical investigation, the patient passed away. The autopsy disclosed an HCC involving the right hepatic lobe, with the invasion of the IVC and the RA. The authors highlight the importance of recognizing the bizarre presentation of not so rare diseases.
Collapse
Affiliation(s)
- Vera Demarchi Aiello
- Universidade de São Paulo (USP), Medical School, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
| | - Ryan Yukimatsu Tanigawa
- Universidade de São Paulo (USP), Medical School, Department of Pathology. São Paulo, SP, Brazil
| | - Rodrigo Caruso Chate
- Universidade de São Paulo (USP), Medical School, Hospital das Clínicas, Division of Radiology. São Paulo, SP, Brazil
| | | | - Alfredo José Mansur
- Universidade de São Paulo (USP), Medical School, Heart Institute, General Outpatient Clinics, Division of Clinical Cardiology. São Paulo, SP, Brazil
| |
Collapse
|
14
|
Affiliation(s)
- Henrique Trombini Pinesi
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | - Tânia Mara Varejão Strabelli
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| |
Collapse
|
15
|
Reis FPD, Campos SV, Aiello VD, Duarte MIS, Samano MN, Pego-Fernandes PM. Gastrointestinal mucormycosis post lung transplantation. Braz J Infect Dis 2019; 23:368-370. [PMID: 31476279 PMCID: PMC9428012 DOI: 10.1016/j.bjid.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/12/2022] Open
|
16
|
Manso PH, Moreira VDM, Aiello VD. Scimitar sign in the absence of anomalous pulmonary venous drainage: a case report. Eur Heart J Case Rep 2019; 3:5476575. [PMID: 31449598 PMCID: PMC6601148 DOI: 10.1093/ehjcr/ytz050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/02/2019] [Indexed: 11/20/2022]
Abstract
Background Scimitar syndrome consists of anomalous pulmonary vein drainage to the inferior vena cava. Its name derives from the image this anomalous pulmonary vein creates on a chest radiograph. We describe a case of normal venous pulmonary vein drainage that also presented the scimitar sign due to an aorto-collateral vessel. Case summary A 15-month-old girl presented with mild dyspnoea and fever. Control chest X-ray showed an image of cardiac dextroposition, hypoplastic right lung, and the ‘scimitar sign’. Although the transthoracic echocardiogram confirmed the initial suspicion of anomalous pulmonary venous drainage, the computed tomography (CT) scan showed normal right pulmonary veins connected to the left atrium and revealed that an aorto-collateral vessel caused the scimitar sign. Discussion Although the patient had several typical alterations of the scimitar syndrome, the pulmonary venous connection was normal, and the scimitar sign was due to an aorto-collateral vessel. It might be difficult to describe venous pulmonary connections on the basis of echocardiography, so an angio CT scan proved to be a valuable tool in this scenario.
Collapse
Affiliation(s)
- Paulo Henrique Manso
- Ribeirão Preto Medical School-University of São Paulo, Avenida Bandeirantes 3900, Ribeirao Preto-SP, Brazil
| | - Valéria de Melo Moreira
- Heart Institute-University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar 44, 05403-900São Paulo-SP, Brazil
| | - Vera Demarchi Aiello
- Heart Institute-University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar 44, 05403-900São Paulo-SP, Brazil
| |
Collapse
|
17
|
de Moura EGH, Ponte-Neto AM, Tsakmaki A, Aiello VD, Bewick GA, Brunaldi VO. Histologic assessment of the intestinal wall following duodenal mucosal resurfacing (DMR): a new procedure for the treatment of insulin-resistant metabolic disease. Endosc Int Open 2019; 7:E685-E690. [PMID: 31098390 PMCID: PMC6519358 DOI: 10.1055/a-0862-0263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/04/2019] [Accepted: 01/29/2019] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background and study aims Minimally invasive procedures that replicate aspects of bariatric surgery with more favorable safety and tolerability offer an attractive alternative in management of metabolic disease. Duodenal mucosal resurfacing (DMR), an endoscopic procedure using hydrothermal ablation, is designed to remove surface epithelium to allow subsequent epithelial regeneration and a reset to a more insulin-sensitive state.
Materials and methods DMR was performed on a healthy pig under general anethesia, approximating the procedure designed for use in humans. Immediately post-DMR, analysis of the histological landscape was conducted in distinct duodenal areas that received ablation treatment.
Results DMR submucosal lift and hydrothermal ablation elicited disruption of villous tips and partial disruption of the crypt base with no damage to deeper tissue. Excessive ablation (purposeful double ablation exposure) did incur damage to the underlying muscle layer.
Conclusion Our results confirmed that DMR elicits superficial ablation of duodenal villi and crypts. Defining the cellular consequences of ablation and regeneration of the epithelium will aid our understanding of how and why DMR affects metabolic homeostasis.
Collapse
Affiliation(s)
- Eduardo G. H. de Moura
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
| | - Alberto M. Ponte-Neto
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
| | - Anastasia Tsakmaki
- Diabetes Research Group, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Vera Demarchi Aiello
- Laboratory of Pathology, Hearth Institute (InCor), Hospital das Clínicas da Faculdade de Medicine da Universidade de São Paulo, Brazil
| | - Gavin A. Bewick
- Diabetes Research Group, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK,Corresponding author Gavin A. Bewick, PhD School of Life Course Sciences6N5 Commonwealth BuildingHammersmith CampusKing’s College LondonLondon SE1 1ULUK+44 (0)73 4459 3806
| | - Vitor O. Brunaldi
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
18
|
Favarato D, Aiello VD. Case 1/2019 - A 51-year-old Man with Arterial Hypertension, Aortic Dissection and Aortic Valve Regurgitation, in Addition to Heart Failure with Unchanged Clinical Course After Surgical Intervention. Arq Bras Cardiol 2019; 112:204-210. [PMID: 30785587 PMCID: PMC6371819 DOI: 10.5935/abc.20190013] [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] [Indexed: 11/25/2022] Open
Affiliation(s)
- Desiderio Favarato
- Instituto do Coração (Incor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração (Incor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| |
Collapse
|
19
|
Chokr MO, de Moura LG, Aiello VD, Bruzzamolino Teixeira KP, de Souza OF, Scanavacca MI. Atrioventricular nodal reentrant tachycardia and persistent left superior vena cava: A tough nut to crack. Successful ablation with transseptal approach. HeartRhythm Case Rep 2018; 4:589-593. [PMID: 30581739 PMCID: PMC6301891 DOI: 10.1016/j.hrcr.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Muhieddine O Chokr
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil.,Hospital Brasil - Rede D'or, Santo André, Brazil
| | - Lucas G de Moura
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Vera Demarchi Aiello
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | |
Collapse
|
20
|
Nunes RAB, Ramirez HSM, Aiello VD. Case 6 - Woman with Ischemic Heart Disease Admitted due to Chest Pain and Shock. Arq Bras Cardiol 2018; 111:860-863. [PMID: 30517382 PMCID: PMC6263468 DOI: 10.5935/abc.20180231] [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: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rafael Amorim Belo Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, SP - Brazil
| | - Hilda Sara Montero Ramirez
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, SP - Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, SP - Brazil
| |
Collapse
|
21
|
Affiliation(s)
- Felippe Lazar Neto
- Universidade de São Paulo, School of Medicine, Internal Medicine Department. São Paulo, SP, Brazil
| | - Laís Costa Marques
- Universidade de São Paulo, School of Medicine, Internal Medicine Department. São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Universidade de São Paulo (USP), School of Medicine, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
| |
Collapse
|
22
|
Arduine GA, Aiello VD. Case 3/2018 - A 60-year-old Female with Chagasic Heart Disease, Admitted Due to Heart Failure Decompensation, Cachexia and Pulmonary Infection. Arq Bras Cardiol 2018; 110:588-596. [PMID: 30226919 PMCID: PMC6023635 DOI: 10.5935/abc.20180100] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gustavo Alonso Arduine
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| |
Collapse
|
23
|
Favarato D, Aiello VD. Case 4 - A 59-Year-Old Woman with Rheumatic Mitral Valve Disease (Severe Stenosis and Regurgitation), Severe Dyspnea, Shock and Pulmonary Condensation. Arq Bras Cardiol 2018; 111:215-222. [PMID: 30183990 PMCID: PMC6122908 DOI: 10.5935/abc.20180157] [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: 07/04/2018] [Accepted: 08/06/2018] [Indexed: 11/20/2022] Open
|
24
|
de Campos FPF, Kanegae MY, Aiello VD, Dos Santos PJ, Gratão TC, Silva ES. Traumatic injury to the internal carotid artery by the hyoid bone: a rare cause of ischemic stroke. Autops Case Rep 2018. [PMID: 29515985 PMCID: PMC5828292 DOI: 10.4322/acr.2018.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Central nervous system (CNS) ischemic events, besides being a common and devastating disease, are accompanied by severe disability and other morbidities. The cause of such events is not always that simple to diagnose, and among the young, a broad spectrum of possibilities should be considered. We present the case of a young man who presented two episodes of CNS ischemia with a 1 year gap between them, which occurred in the same situation while he was walking and carrying a heavy backpack. The second event first presented as a transient ischemic attack followed by a stroke the day after. The diagnostic work-up showed an indentation of the greater cornu of the hyoid bone over the internal carotid artery, which injured the media and intimal layers. At the arterial injury site, a micro thrombus was found, which explained the source of the embolic event to the CNS. The patient was operated on, and the procedure included the resection of the posterior horn of the hyoid bone, the resection of the injured segment of the internal carotid artery followed by carotid–carotid bypass with the great saphenous vein. The postoperative period and the recovery were uneventful as was the 5-month follow-up. We call attention to this unusual cause of stroke and present other cases reported in the literature.
Collapse
Affiliation(s)
| | - Marcia Yoshie Kanegae
- University of São Paulo (USP), Hospital Universitário, Internal Medicine Department. São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- University of São Paulo (USP), Heart Institute, School of Medicine, Laboratory of Pathology. São Paulo, SP, Brazil
| | - Pedro José Dos Santos
- University of São Paulo (USP), Hospital Universitário, Department of Radiology. São Paulo, SP, Brazil
| | - Tatiane Carneiro Gratão
- University of São Paulo (USP), Hospital das Clínicas, School of Medicine, Department of Surgery, Vascular and Endovascular Division. São Paulo, SP, Brazil
| | - Erasmo Simão Silva
- University of São Paulo (USP), Hospital das Clínicas, School of Medicine, Department of Surgery, Vascular and Endovascular Division. São Paulo, SP, Brazil
| |
Collapse
|
25
|
Grossi VGR, Lee K, Demarchi LM, Castelli JB, Aiello VD. Occurrence of mesothelial/monocytic incidental cardiac excrescences in material from open-heart procedures: case reports and literature review. Autops Case Rep 2018. [PMID: 29515977 PMCID: PMC5828284 DOI: 10.4322/acr.2018.002] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mesothelial/monocytic incidental cardiac excrescences (MICE) are unusual findings during the histological analysis of material from the pericardium, mediastinum, or other tissues collected in open-heart surgery. Despite their somewhat worrisome histological appearance, they show a benign clinical course, and further treatment is virtually never necessary. Hence, the importance of recognizing the entity relays in its differential diagnosis, as an unaware medical pathologist may misinterpret it for a malignant neoplasm. Other mesothelial and histiocytic proliferative lesions, sharing very close histological morphology and immunohistochemistry features with MICE, have been described in sites other than the heart or the mediastinum. This similarity has led to the proposal of the common denomination "histiocytosis with raisinoid nuclei." We report three cases from the pathology archives of the Heart Institute of São Paulo University (Incor/HC-FMUSP), diagnosed as "mesothelial/monocytic incidental cardiac excrescence," with immunohistochemical documentation, and provide a literature review of this entity.
Collapse
Affiliation(s)
| | - Karen Lee
- University of São Paulo (USP), School of Medicine, Department of Anatomic Pathology. São Paulo, SP, Brazil
| | - Léa Maria Demarchi
- University of São Paulo (USP), School of Medicine, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
| | - Jussara Bianchi Castelli
- University of São Paulo (USP), School of Medicine, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- University of São Paulo (USP), School of Medicine, Heart Institute, Laboratory of Pathology. São Paulo, SP, Brazil
| |
Collapse
|
26
|
Ribeiro de Campos PT, Lopes AA, Issa VS, Aiello VD. Morphologic and immunohistochemical features of pulmonary vasculopathy in end-stage left ventricular systolic failure. J Heart Lung Transplant 2018; 37:422-425. [PMID: 29198927 DOI: 10.1016/j.healun.2017.11.011] [Citation(s) in RCA: 2] [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] [Received: 07/05/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 12/17/2022] Open
|
27
|
Bruno JDA, Nunes RAB, Gutierrez PS, Aiello VD. Case 5/2017 - A 28-Year-Old Woman with Cor Pulmonale Due to Pulmonary Hypertension Secondary to Chronic Pulmonary Thromboembolism. Arq Bras Cardiol 2017; 109:370-375. [PMID: 29069205 PMCID: PMC5644218 DOI: 10.5935/abc.20170148] [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] [Indexed: 11/20/2022] Open
|
28
|
Marques LC, Paula RSD, Camilo IL, Aiello VD. Case 1/2017 - 26-Year-old Male with Rapidly Progressive Heart Failure. Arq Bras Cardiol 2017; 108:173-183. [PMID: 28327870 PMCID: PMC5344664 DOI: 10.5935/abc.20170018] [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] [Indexed: 11/20/2022] Open
|
29
|
Ramirez HSM, Nunes RAB, Aiello VD. Case 4/2017 - Young Male Marathoner with Heart Failure Due to Dilated Cardiomyopathy. Arq Bras Cardiol 2017. [PMCID: PMC5576122 DOI: 10.5935/abc.20170124] [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] [Indexed: 12/03/2022] Open
Affiliation(s)
| | | | - Vera Demarchi Aiello
- Instituto do Coração (InCor) HC-FMUSP, São
Paulo, SP - Brazil
- Mailing Address: Vera Demarchi Aiello Avenida Dr.
Enéas de Carvalho Aguiar, 44, subsolo, bloco I, Cerqueira César.
Postal Code 05403-000, São Paulo, SP - Brazil E-mail:
,
| |
Collapse
|
30
|
Affiliation(s)
- Vera Demarchi Aiello
- Laboratory of Pathology - Heart Institute - School of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
31
|
Pinto NC, Pomerantzeff PMA, Deana A, Zezell D, Benetti C, Aiello VD, Lopes LA, Jatene FB, Chavantes MC. Descriptive Analysis of In Vitro Cutting of Swine Mitral Cusps: Comparison of High-Power Laser and Scalpel Blade Cutting Techniques. Photomed Laser Surg 2016; 35:87-91. [PMID: 27898268 DOI: 10.1089/pho.2015.3993] [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] Open
Abstract
BACKGROUND AND OBJECTIVES The most common injury to the heart valve with rheumatic involvement is mitral stenosis, which is the reason for a big number of cardiac operations in Brazil. Commissurotomy is the traditional technique that is still widely used for this condition, although late postoperative restenosis is concerning. This study's purpose was to compare the histological findings of porcine cusp mitral valves treated in vitro with commissurotomy with a scalpel blade to those treated with high-power laser (HPL) cutting, using appropriate staining techniques. MATERIALS AND METHODS Five mitral valves from healthy swine were randomly divided into two groups: Cusp group (G1), cut with a scalpel blade (n = 5), and Cusp group (G2), cut with a laser (n = 5). G2 cusps were treated using a diode laser (λ = 980 nm, power = 9.0 W, time = 12 sec, irradiance = 5625 W/cm2, and energy = 108 J). RESULTS In G1, no histological change was observed in tissue. A hyaline basophilic aspect was focally observed in G2, along with a dark red color on the edges and areas of lower birefringence, when stained with hematoxylin-eosin, Masson's trichrome, and Sirius red. Further, the mean distances from the cutting edge in cusps submitted to laser application and stained with Masson's trichrome and Sirius red were 416.7 and 778.6 μm, respectively, never overcoming 1 mm in length. CONCLUSIONS Thermal changes were unique in the group submitted to HPL and not observed in the cusp group cut with a scalpel blade. The mean distance of the cusps' collagen injury from the cutting edge was less than 1 mm with laser treatment. Additional studies are needed to establish the histological evolution of the laser cutting and to answer whether laser cutting may avoid valvular restenosis better than blade cutting.
Collapse
Affiliation(s)
- Nathali Cordeiro Pinto
- 1 Cardiovascular and Thoracic Surgery Department of The Heart Institute, General Hospital, Medical School, University of São Paulo , São Paulo, Brazil
| | - Pablo Maria Alberto Pomerantzeff
- 1 Cardiovascular and Thoracic Surgery Department of The Heart Institute, General Hospital, Medical School, University of São Paulo , São Paulo, Brazil
| | - Alessandro Deana
- 2 Post Graduate Program in Medicine and Biophotonics Applied to Health Sciences, University Nove de Julho , São Paulo, Brazil
| | - Denise Zezell
- 3 Nuclear and Energy Research Institute/Center for Lasers and Applications-IPEN/CLA, University of São Paulo , São Paulo, Brazil
| | - Carolina Benetti
- 3 Nuclear and Energy Research Institute/Center for Lasers and Applications-IPEN/CLA, University of São Paulo , São Paulo, Brazil
| | - Vera Demarchi Aiello
- 4 Pathology Department of Heart Institute, Clinical Hospital, Medical School, University of São Paulo , São Paulo, Brazil
| | - Luciana Almeida Lopes
- 5 Research and Education Center for Phototherapy in Health Sciences , São Carlos, Brazil
| | - Fabio Biscegli Jatene
- 1 Cardiovascular and Thoracic Surgery Department of The Heart Institute, General Hospital, Medical School, University of São Paulo , São Paulo, Brazil
| | - M Cristina Chavantes
- 2 Post Graduate Program in Medicine and Biophotonics Applied to Health Sciences, University Nove de Julho , São Paulo, Brazil
| |
Collapse
|
32
|
Liguori GR, Jatene MB, Ho SY, Aiello VD. Morphological variability of the arterial valve in common arterial trunk and the concept of normality. Heart 2016; 103:848-855. [PMID: 27885047 DOI: 10.1136/heartjnl-2016-310505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/11/2016] [Accepted: 11/01/2016] [Indexed: 11/03/2022] Open
Affiliation(s)
- Gabriel Romero Liguori
- Laboratory of Pathology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Biscegli Jatene
- Pediatric Cardiac Surgery Unit, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Siew Yen Ho
- Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London Faculty of Medicine, London, UK
| | - Vera Demarchi Aiello
- Laboratory of Pathology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
33
|
Magalhães LP, Guimarães I, Melo SL, Mateo E, Andalaft RB, Xavier L, Lorga AM, Fagundes AA, Moreira D, Hachul DT, Sternick EB, Andrea EM, Cannavan F, Oliveira F, Darrieux F, Lima GG, Atié J, Elias J, Zimerman LI, Miana L, Pellanda LC, Sacilotto L, Jatene MB, Soares MM, Binotto MA, Scanavacca MI, Oliveira NA, Zielinsky P, Salerno PR, Teixeira RA, Kuniyoshi RR, Costa R, Schames S, Pedra S, Gimenez SC, Wu TC, Aiello VD. [Not Available]. Arq Bras Cardiol 2016; 107:1-58. [PMID: 27487201 DOI: 10.5935/abc.20160103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
34
|
Affiliation(s)
- Vera Demarchi Aiello
- Laboratory of Pathology - Instituto do Coração - Hospital das Clínicas - Universidade de São Paulo, São Paulo/SP - Brazil
| | | |
Collapse
|
35
|
Pinto NC, Chavantes MC, Zezell D, Deana A, Benetti C, Marcos RL, Lopes LA, Martins RABL, Aiello VD, Jatene FB, Pomerantzeff PMA. The use of a high-power laser on swine mitral valve chordae tendineae. Lasers Med Sci 2016; 31:1075-81. [PMID: 27184152 DOI: 10.1007/s10103-016-1949-0] [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: 02/27/2015] [Accepted: 04/25/2016] [Indexed: 11/28/2022]
Abstract
Worldwide, rheumatic fever remains a significant cause of mitral valve insufficiency. It is responsible for approximately 90 % of early childhood valvular surgeries in Brazil. Elongated or flail chordae are frequently responsible and require surgical correction. The purpose of this study was to analyze and compare the histological tissues of the mitral valve chordae and the mechanical resistance generated by the chordae, both with and without the application of a high-power laser. Twenty normal porcine mitral valve chordae were measured and divided randomly into the following two groups: control group (not subjected to a high-power laser) and laser group (subjected to photonic irradiation). Laser surgery was performed under controlled conditions, using following parameters: λ = 980-nm wavelength, power = 3 W, and energy = 60 J. A mechanical test machine was used in combination with a subsequent histological study to measure chordae tensile properties. A histological analysis demonstrated a typical collagen bundle arrangement in the control group; however, under a particular reached temperature range (48), the collagen bundles assumed different arrangements in the laser group. Significant reductions in the chordae tendineae lengths and changes in their resistance in the laser group were observed, as these chordae exhibited less rigid fibers. The chordae tendineae of normal porcine valves subjected to a high-power laser exhibited its length reduction and less stiffness compared to the control group. A histological analysis of the laser treatment specimens demonstrated differences in collagen bundle spatial organization, following slight changes into tissue temperature.
Collapse
Affiliation(s)
- Nathali Cordeiro Pinto
- Cardiovascular and Thoracic Surgery Department of The Heart Institute - General Hospital, Medical School, University of São Paulo, 44, Dr. Enéas de Carvalho Aguiar Avenue, 2nd floor, 05403-900, São Paulo, SP, Brazil. .,Valvar Surgery Department of Heart Institute - Clinical Hospital, Medical School, University of São Paulo, 44, Av.Dr. Eneas de Carvalho Aguiar, 2nd floor, 05403-900, São Paulo, SP, Brazil.
| | - M Cristina Chavantes
- Cardiovascular and Thoracic Surgery Department of The Heart Institute - General Hospital, Medical School, University of São Paulo, 44, Dr. Enéas de Carvalho Aguiar Avenue, 2nd floor, 05403-900, São Paulo, SP, Brazil.,Post Graduate Program in Biophotonics and Medicine, University Nove de Julho, 235, Vergueiro, 01504-001, São Paulo, SP, Brazil
| | - Denise Zezell
- Nuclear and Energy Research Institute/Center for Lasers and Applications-IPEN/CLA, University of São Paulo, 2242, Professor Lineu Prestes Avenue, 05508-900, São Paulo, SP, Brazil
| | - Alessandro Deana
- Post Graduate Program in Biophotonics and Medicine, University Nove de Julho, 235, Vergueiro, 01504-001, São Paulo, SP, Brazil
| | - Carolina Benetti
- Nuclear and Energy Research Institute/Center for Lasers and Applications-IPEN/CLA, University of São Paulo, 2242, Professor Lineu Prestes Avenue, 05508-900, São Paulo, SP, Brazil
| | - Rodrigo Labat Marcos
- Post Graduate Program in Biophotonics and Medicine, University Nove de Julho, 235, Vergueiro, 01504-001, São Paulo, SP, Brazil
| | - Luciana Almeida Lopes
- Research and Education Center for Phototherapy in Health Sciences, 831, Sebastião Moraes, 13562-030, São Carlos, SP, Brazil
| | - Rodrigo A B Lopes Martins
- Institute of Biomedical Sciences - ICB, University of São Paulo, 2415, Professor Lineu Prestes Avenue, Cidade Universitária, 05508-900, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Pathology Department of Heart Institute - Clinical Hospital, Medical School, University of São Paulo, 44, Dr. Enéas de Carvalho Aguiar Avenue, SS floor, 05403-900, São Paulo, SP, Brazil
| | - Fabio Biscegli Jatene
- Cardiovascular and Thoracic Surgery Department of The Heart Institute - General Hospital, Medical School, University of São Paulo, 44, Dr. Enéas de Carvalho Aguiar Avenue, 2nd floor, 05403-900, São Paulo, SP, Brazil
| | - Pablo M A Pomerantzeff
- Cardiovascular and Thoracic Surgery Department of The Heart Institute - General Hospital, Medical School, University of São Paulo, 44, Dr. Enéas de Carvalho Aguiar Avenue, 2nd floor, 05403-900, São Paulo, SP, Brazil.,Valvar Surgery Department of Heart Institute - Clinical Hospital, Medical School, University of São Paulo, 44, Av.Dr. Eneas de Carvalho Aguiar, 2nd floor, 05403-900, São Paulo, SP, Brazil
| |
Collapse
|
36
|
Marçula M, Aiello VD. Case 5/2015 - 88-Year-Old Female with Chronic Coronary Artery Disease, Upper Limb Thrombosis, Atrial Fibrillation and Cardiac Arrest. Arq Bras Cardiol 2015; 105:527-35. [PMID: 26577720 PMCID: PMC4651412 DOI: 10.5935/abc.20150143] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Magaly Marçula
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
37
|
Mustafa S, Yamada AT, Lima FM, Carvalho VM, Aiello VD, Castelli JB. Case 4--A 79-Year-Old Man with Congestive Heart Failure Due to Restrictive Cardiomyopathy. Arq Bras Cardiol 2015; 105:430-9. [PMID: 26559991 PMCID: PMC4633008 DOI: 10.5935/abc.20150135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Sumaia Mustafa
- HC, FM, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | |
Collapse
|
38
|
Penha JGD, Zorzanelli L, Barbosa-Lopes AA, Atik E, Miana LA, Tanamati C, Caneo LF, Miura N, Aiello VD, Jatene MB. Palliative Senning in the Treatment of Congenital Heart Disease with Severe Pulmonary Hypertension. Arq Bras Cardiol 2015; 105:353-61. [PMID: 26559982 PMCID: PMC4632999 DOI: 10.5935/abc.20150097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/18/2015] [Indexed: 11/20/2022] Open
Abstract
Background Transposition of the great arteries (TGA) is the most common cyanotic cardiopathy,
with an incidence ranging between 0.2 and 0.4 per 1000 live births. Many patients
not treated in the first few months of life may progress with severe pulmonary
vascular disease. Treatment of these patients may include palliative surgery to
redirect the flow at the atrial level. Objective Report our institutional experience with the palliative Senning procedure in
children diagnosed with TGA and double outlet right ventricle with severe
pulmonary vascular disease, and to evaluate the early and late clinical
progression of the palliative Senning procedure. Methods Retrospective study based on the evaluation of medical records in the period of
1991 to 2014. Only patients without an indication for definitive surgical
treatment of the cardiopathy due to elevated pulmonary pressure were included. Results After one year of follow-up there was a mean increase in arterial oxygen
saturation from 62.1% to 92.5% and a mean decrease in hematocrit from 49.4% to
36.3%. Lung histological analysis was feasible in 16 patients. In 8 patients,
pulmonary biopsy grades 3 and 4 were evidenced. Conclusion The palliative Senning procedure improved arterial oxygen saturation, reduced
polycythemia, and provided a better quality of life for patients with TGA with
ventricular septal defect, severe pulmonary hypertension, and poor prognosis.
Collapse
Affiliation(s)
- Juliano Gomes da Penha
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leina Zorzanelli
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Edimar Atik
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leonardo Augusto Miana
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carla Tanamati
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Fernando Caneo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nana Miura
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
39
|
Aiello VD, de Campos FPF. Chronic Chagas cardiomyopathy. Autops Case Rep 2015; 5:7-9. [PMID: 26558241 PMCID: PMC4636100 DOI: 10.4322/acr.2015.012] [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] [Indexed: 11/23/2022] Open
Affiliation(s)
- Vera Demarchi Aiello
- Pathology Laboratory - Instituto do Coração - Hospital das Clínicas - University of São Paulo, São Paulo/SP - Brazil
| | | |
Collapse
|
40
|
Pinheiro BA, Yamada AT, Aiello VD. Case 02/2015 - A 67 Year-Old Woman with Sudden Cardiogenic Shock in the 7th Day after Acute Myocardial Infarction. Arq Bras Cardiol 2015; 105:86-92. [PMID: 26270068 PMCID: PMC4523292 DOI: 10.5935/abc.20150079] [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] [Indexed: 11/21/2022] Open
Affiliation(s)
- Bruno Aguiar Pinheiro
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Alice Tatsuko Yamada
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Vera Demarchi Aiello
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| |
Collapse
|
41
|
Hotta VT, Aiello VD. Correct anatomical orientation of the heart and reflections on the nomenclature used in daily practice. Arq Bras Cardiol 2015; 104:e34-6. [PMID: 25993600 PMCID: PMC4415873 DOI: 10.5935/abc.20150029] [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: 08/27/2014] [Accepted: 01/12/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Viviane Tiemi Hotta
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
42
|
Abstract
To repair congenital heart defects by means of open heart surgery, the surgeon needs guidance about the location and distribution of the specialized conduction tissues, in order to avoid their direct damage and consequent conduction disturbances. This review addresses the historical steps of the morphological study of the conduction system in different types of heart defects, providing updated information about the subject.
Collapse
Affiliation(s)
- Vera Demarchi Aiello
- Laboratory of Pathology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
43
|
Ferreira CR, Aiello VD, de Melo AMAGP, Mota LB, de Carvalho ACN, Souza HSP, Rangel DADS. Classic form of hypoplastic left heart syndrome diagnosed post-natally: an autopsy report. Autops Case Rep 2014; 4:21-30. [PMID: 28573115 PMCID: PMC5444395 DOI: 10.4322/acr.2014.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/07/2014] [Indexed: 11/24/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) is a congenital heart disease, which, despite the current improved knowledge about its management and surgical treatment, is still associated with high mortality, especially in the early neonatal period and before the second stage of reconstruction surgery. The low rate of prenatal diagnosis and delayed diagnostic suspicion results in unsuccessful therapeutic intervention, even though the real impact of early diagnosis and intervention on mortality and quality of life of patients is still uncertain. Fortunately, this syndrome of challenging treatment is not that frequent. It involves a spectrum of obstructions to the blood flow within the left heart and is characterized by an inappropriate size of the left ventricle associated with a wide variety of valvular dysfunctions. Treatment ranges from heart transplantation to palliative surgical procedures. The authors describe a case of a newborn with HLHS, whose diagnosis was made after birth because of early respiratory failure. Despite the use of prostaglandin the newborn died. An autopsy was performed and the anatomical findings were described.
Collapse
Affiliation(s)
- Cristiane Rúbia Ferreira
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Vera Demarchi Aiello
- Laboratory of Pathology - Instituto do Coração - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Lucas Braga Mota
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Ana Carolina Neves de Carvalho
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Heli Samuel Pinto Souza
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Diana Arrais de Souza Rangel
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
44
|
Aiello VD, Thomaz AM, Pozzan G, Lopes AA. Capillary hemangiomatosis like-lesions in lung biopsies from children with congenital heart defects. Pediatr Pulmonol 2014; 49:E82-5. [PMID: 24019248 DOI: 10.1002/ppul.22889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 04/17/2013] [Accepted: 07/06/2013] [Indexed: 11/11/2022]
Abstract
The morphological findings in the lung vessels of children with pulmonary arterial hypertension associated with uncorrected congenital cardiac shunts may be qualitatively and quantitatively assessed by lung biopsy in selected cases. Among 297 lung biopsies collected over a period of 11 years two cases were detected presenting the typical findings of pulmonary capillary hemangiomatosis, a rare disorder usually associated with pulmonary veno-occlusive disease. We report the clinical and histological findings and discuss about the impact of this unexpected and not-previously described associated lesion on the prognosis and on the therapeutic strategy in patients with pulmonary hypertension associated with congenital heart disease.
Collapse
Affiliation(s)
- Vera Demarchi Aiello
- Laboratory of Pathology, Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | | | | | | |
Collapse
|
45
|
Gutierrez PS, Aiello VD. Aortic stenosis concomitant with microscopic polyangiitis: a challenge in medical reasoning and thinking. Autops Case Rep 2014; 4:7-14. [PMID: 28652987 PMCID: PMC5470560 DOI: 10.4322/acr.2014.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/20/2014] [Indexed: 11/24/2022]
Abstract
Microscopic polyangiitis (MPA) is part of the anti-neutrophil cytoplasmic antibodies (ANCA)-related vasculitis, which usually presents as renal pulmonary syndrome. It is defined as a pauci-immune necrotizing small vessel vasculitis, which usually affects the kidneys, followed by the lungs. It also presents systemic symptoms. The etiology of MPA is still unclear, but evidence reinforces the autoimmune mechanisms as the main etiopathogenic factor. Aortic valve stenosis (AS) is not an uncommon disease whose etiology varies according to geographical differences and the patient's age. The natural history of AS begins with a prolonged asymptomatic period, but when symptomatic, respiratory failure is one of its main clinical presentations. The authors present the case of a 55-year-old woman who was admitted with the diagnosis of renal failure, anemia, and a cardiac murmur. The patient had been recently diagnosed with pneumonia. During hospitalization, diagnostic workup disclosed a normal kidney size as well as parenchymal thickness. A renal biopsy was undertaken but the specimen was exiguous, showing 4 sclerotic glomeruli and 1 glomerulus with crescentic glomerulonephritis. The search for ANCA was positive. The investigation of the cardiac murmur disclosed AS. The patient, on hemodialysis, presented episodes of respiratory failure, which was interpreted as acute pulmonary edema, but a suspicion of ANCA-related pulmonary renal syndrome was raised. However, the aortic valve replacement was prioritized. While awaiting cardiac surgery, the patient died because of respiratory insufficiency. Autopsy findings concluded that MPA with pulmonary hemorrhage due to vasculitis was the immediate cause of death. Although AS was present at autopsy and classified as moderate/severe, this lesion was a bystander in the process of this patient's end of life, demonstrating the value of autopsy for medical learning and reasoning purposes.
Collapse
Affiliation(s)
- Paulo Sampaio Gutierrez
- Laboratory of Pathology - Instituto do Coração - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Vera Demarchi Aiello
- Laboratory of Pathology - Instituto do Coração - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| |
Collapse
|
46
|
Forster R, de Campos FPF, Lovisolo SM, Aiello VD, Martines JADS. Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium. Autops Case Rep 2013; 3:13-22. [PMID: 28584802 PMCID: PMC5453656 DOI: 10.4322/acr.2013.034] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/07/2013] [Indexed: 01/16/2023] Open
Abstract
Although infective endocarditis (IE) has been described in reports dating from the Renaissance, the diagnosis still challenges and the outcome often surprises. In the course of time, diagnostic criteria have been updated and validated to reduce misdiagnosis. Some risk factors and epidemiology have shown dynamic changes since degenerative valvular disease became more predominant in developed countries, and the mean age of the affected population increased. Despite streptococci have been being well known as etiologic agents, some groups, although rare, have been increasingly reported (e.g., Streptococcus milleri.) Intracardiac complications of IE are common and have a worse prognosis, frequently requiring surgical treatment. We report a case of a middle-aged diabetic man who presented with prolonged fever, weight loss, and ultimately severe dyspnea. IE was diagnosed based on a new valvular regurgitation murmur, a positive blood culture for Streptococcus anginosus, an echocardiographic finding of an aortic valve vegetation, fever, and pulmonary thromboembolism. Despite an appropriate antibiotic regimen, the patient died. Autopsy findings showed vegetation attached to a bicuspid aortic valve with an associated septal abscess and left ventricle and aortic root fistula connecting with the pulmonary artery. A large thrombus was adherent to the pulmonary artery trunk and a pulmonary septic thromboemboli were also identified.
Collapse
Affiliation(s)
- Robert Forster
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Silvana Maria Lovisolo
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Vera Demarchi Aiello
- Laboratory of Pathology - Instituto do Coração - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | |
Collapse
|
47
|
Abduch MCD, Assad RS, Mathias W, Aiello VD. The echocardiography in the cardiovascular laboratory: a guide to research with animals. Arq Bras Cardiol 2013; 102:97-103. [PMID: 24652090 PMCID: PMC3987390 DOI: 10.5935/abc.20130239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/29/2013] [Indexed: 01/08/2023] Open
Abstract
The feasibility and potential for the morphological and hemodynamic investigation of
the heart has been increasing the use of the echocardiography in the research
setting. Additionally, the development of new technologies, like the real time 3D
echocardiography and speckle tracking, demands validation throughout experimental
studies before being instituted in the clinical setting. This paper aims to provide information concerning the particularities of the
echocardiographic examination in quadruped mammals, targeting the experimental
research.
Collapse
Affiliation(s)
| | - Renato Samy Assad
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil
| | - Wilson Mathias
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil
| | - Vera Demarchi Aiello
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brasil
| |
Collapse
|
48
|
Pinto NC, Pomerantzeff PMA, Deana A, Zezell D, Marcos RL, Martins RABL, Aiello VD, Jatene FB, Lopes LA, Chavantes MC. High power laser in chordae tendineae to improve heart mitral regurgitation: an experimental study in swine. J Cardiothorac Surg 2013. [PMCID: PMC3845833 DOI: 10.1186/1749-8090-8-s1-o282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
49
|
De Brito T, Aiello VD, da Silva LFF, Gonçalves da Silva AM, Ferreira da Silva WL, Castelli JB, Seguro AC. Human hemorrhagic pulmonary leptospirosis: pathological findings and pathophysiological correlations. PLoS One 2013; 8:e71743. [PMID: 23951234 PMCID: PMC3741125 DOI: 10.1371/journal.pone.0071743] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/26/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Leptospirosis is a re-emerging zoonosis with protean clinical manifestations. Recently, the importance of pulmonary hemorrhage as a lethal complication of this disease has been recognized. In the present study, five human necropsies of leptospirosis (Weil's syndrome) with extensive pulmonary manifestations were analysed, and the antibodies expressed in blood vessels and cells involved in ion and water transport were used, seeking to better understand the pathophysiology of the lung injury associated with this disease. PRINCIPAL FINDINGS Prominent vascular damage was present in the lung microcirculation, with decreased CD34 and preserved aquaporin 1 expression. At the periphery and even inside the extensive areas of edema and intraalveolar hemorrhage, enlarged, apparently hypertrophic type I pneumocytes (PI) were detected and interpreted as a non-specific attempt of clearence of the intraalveolar fluid, in which ionic transport, particularly of sodium, plays a predominant role, as suggested by the apparently increased ENaC and aquaporin 5 expression. Connexin 43 was present in most pneumocytes, and in the cytoplasm of the more preserved endothelial cells. The number of type II pneumocytes (PII) was slightly decreased when compared to normal lungs and those of patients with septicemia from other causes, a fact that may contribute to the progressively low PI count, resulting in deficient restoration after damage to the alveolar epithelial integrity and, consequently, a poor outcome of the pulmonary edema and hemorrhage. CONCLUSIONS Pathogenesis of lung injury in human leptospirosis was discussed, and the possibility of primary non-inflammatory vascular damage was considered, so far of undefinite etiopathogenesis, as the initial pathological manifestation of the disease.
Collapse
Affiliation(s)
- Thales De Brito
- Institute of Tropical Medicine, São Paulo University Medical School, São Paulo, Brazil.
| | | | | | | | | | | | | |
Collapse
|
50
|
Miranda GB, Aiello VD. Case 2: sudden death after coronary artery bypass surgery in a 49-year-old female, diabetic, dyslipidemic, hypertensive, obese patient. Arq Bras Cardiol 2013; 100:e54-8. [PMID: 23740435 DOI: 10.5935/abc.20130106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|