ESTELA AZEKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation(2015) CANEO, Luiz Fernando; MIANA, Leonardo Augusto; TANAMATI, Carla; PENHA, Juliano Gomes; SHIMODA, Monica Satsuki; AZEKA, Estela; MIURA, Nana; GALAS, Filomena Regina Barbosa Gomes; GUIMARAES, Vanessa Alves; JATENE, Marcelo BiscegliBackground: Heart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure. Objective: To evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy. Methods: Retrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy. Results: We used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n = 10), eight died waiting and 2 patients (20%) were transplanted, but none was discharged. In group B (n = 9), 6 patients (66.7%) were transplanted and three were discharged. The mean support time was 21,8 days (6 to 984h). The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and causeof death in group A while neurologic complications were more prevalent en group B. Conclusion: Mechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.
- The past, present and future of clinical research(2011) AZEKA, Estela; FREGNI, Felipe; AULER JUNIOR, Jose Otavio Costa
- Desmoid tumour of the chest wall in paediatric post-operatory of heart transplant(2022) FILHO, Orival de Freitas; NAKAHIRA, Evelyn Sue; SCHMIDT JUNIOR, Aurelino Fernandes; AZEKA, Estela; JATENE, Marcelo Biscegli; PEGO-FERNARDES, Paulo ManuelWe will report a case of a desmoid tumour (DT), which developed at the surgical site of the pacemaker after a late childhood heart transplant. Patients with idiopathic dilated cardiomyopathy followed up in the paediatric cardiology service. It evolved with the dissociation of ventricular rhythm caused by severe heart failure, which led to the implantation of a cardiac resynchronization device prior to heart transplantation. The progression to end-stage heart disease culminated in a heart transplant at 12 years old. One year after the transplant, at the age of 13 years, he presented a progressively growing mass on the generator site of the resynchronization device. The initial decision was to remove the device. During the removal surgery, there was no haematoma or fluid collection. However, there was a progression of the lesion. The lesion was biopsied with the anatomopathological diagnosis of a DT. Resection surgery happened 4 months after the start of the mass growth. At that time, the tumour reached 20 cm in diameter. The lesion infiltrated the pectoralis major muscle and this muscle was resected partially en bloc with the lesion. The defect had primary closure. The patient evolved without postoperative complications and was discharged on the 14th postoperative day. The surgical specimen came with negative circumferential margins. However, the deep margin was microscopically positive. Due to deep involvement, the patient underwent adjuvant radiotherapy. Currently, the patient is under clinical follow-up and has no evidence of tumour recurrence. DT is a rare tumour, with unpredictable courses. Surgery can be considered in the progression of lesions. Treatment is justified by long survival after a heart transplant and in DT patients. DT is a differential diagnosis to be considered in progressive growth lesions.
- Rational Use of Mechanical Circulatory Support as a Bridge to Pediatric and Congenital Heart Transplantation(2018) MIANA, Leonardo A.; SILVA, Guilherme Viotto Rodrigues da; CANEO, Luiz Fernando; TURQUETTO, Aida Luisa; TANAMATI, Carla; FORONDA, Gustavo; MASSOTI, Maria Raquel; PENHA, Juliano G.; AZEKA, Estela; GALAS, Filomena R. B. G.; JATENE, Fabio B.; JATENE, Marcelo B.Introduction: Donor shortage and organ allocation is the main problem in pediatric heart transplant. Mechanical circulatory support is known to increase waiting list survival, but it is not routinely used in pediatric programs in Latin America. Methods: All patients listed for heart transplant and supported by a mechanical circulatory support between January 2012 and March 2016 were included in this retrospective single-center study. The endpoints were mechanical circulatory support time, complications, heart transplant survival and discharge from the hospital. Results: Twenty-nine patients from our waiting list were assessed. Twelve (45%) patients were initially supported by extracorporeal membrane oxygenation (ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five patients initially supported by ECMO were bridged to another device. One was bridged to a centrifugal pump and four were bridged to Berlin Heart Excor (R). Among the 29 supported patients, 18 (62%) managed to have a heart transplant. Thirty-day survival period after heart transplant was 56% (10 patients). Median support duration was 12 days (interquartile range [IQR] 4-26 days) per run and the waiting time for heart transplant was 9.5 days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality predictor (OR=22.6 [CI=1.04-494.6]; P=0.04). Conclusion: Mechanical circulatory support was able to bridge most INTERMACS 1 and 2 pediatric patients to transplant with an acceptable complication rate. Acute renal failure increased mortality after mechanical circulatory support in our experience.
- Clinical research in pediatric organ transplantation(2014) AZEKA, Estela; SAAVEDRA, Laura Castillo; FREGNI, FelipeSolid organ transplantation has greatly improved survival in children with end-stage disease, becoming one of the main treatment options in this population. Nonetheless, there are significant challenges associated with validating and optimizing the effects of these interventions in clinical trials. Therefore, we reviewed the main issues related to conducting clinical transplantation research in children. We divided these challenges into three different categories: (i) challenges related to surgical techniques and anesthetic procedures, (ii) challenges related to post-transplant care and (iii) challenges specific to a particular population group and disease type. Some of the observed burdens for clinical research in this field are related to the limitations of conducting studies with a placebo or sham procedure, determining the standard of care for a control group, low prevalence of cases, ethical concerns related to use of a placebo control group and lack of generalizability from animal studies and clinical trials conducted in adult populations. To overcome some of these barriers, it is necessary to utilize alternative clinical trial designs, such as observational studies or non-inferiority trials, and to develop multicenter collaborations to increase the recruitment rate. In conclusion, the lack of robust data related to pediatric transplantation remains problematic, and further clinical trials are needed to develop more efficacious and safer treatments.
- I DIRETRIZ DE INSUFICIÊNCIA CARDÍACA (IC) E TRANSPLANTE CARDÍACO, NO FETO, NA CRIANÇA E EM ADULTOS COM CARDIOPATIA CONGÊNITA, DA SOCIEDADE BRASILEIRA DE CARDIOLOGIA(2014) AZEKA, E.; JATENE, M. B.; JATENE, I. B.; HOROWITZ, E. S. K.; BRANCO, K. C.; SOUZA NETO, J. D.; MIURA, N.; MATTOS, S.; AFIUNE, J. Y.; TANAKA, A. C.; SANTOS, C. C. L.; GUIMARAES, I. C. B.; MANSO, P. H.; PELLIZARI, R. C. R. S.; SANTOS, M. V. C.; THOMAZ, A. M.; CRISTOFANI, L. M.; RIBEIRO, A. C. L.; KULIKOWSKI, L. D.; SAMPAIO, M. C.; PEREIRA, A. C.; SOARES, A. M.; SOARES JUNIOR, J.; OH, G. H. Y.; MOREIRA, V; MOTA, C. C. C.; AFIUNE, C. M. C.; PEDRA, C.; PEDRA, S.; PEDROSA, A.; GUIMARAES, V; CANEO, L. F.; FERREIRO, C. R.; CAVALHEIRO FILHO, C.; STEFANELLO, B.; NEGRAO, C. E.; TURQUETTO, A. L. R.; MESQUITA, S. M. F.; MAEDA, W. T.; ZORZANELLI, L.; PANAJOTOPOLOS, N.; SIQUEIRA, A. W. S.; GALAS, F. R. B.; HAJJAR, L. A.; BENVENUTI, L. A.; VINCENZI, P.; ODONE, V; LOPES, M. H.; V, T. M. Strabelli; FRANCHI, S. M.; TAKEUTI, A. D.; DUARTE, M. F.; LEON, R. G. P.; HERMIDA, R. P. M.; SORPRESO, I. C. E.; SOARES JUNIOR, J. M.; MELO, N. R.; BARACAT, E. C.; BORTOLOTTO, M. R. F. L.; SCANAVACCA, M.; SHIMODA, M. S.; FORONDA, G.; ROMANO, B. W.; SILVA, D. B.; OMURA, M. M.; BARBEIRO, C. P. M.; VINHOLE, A. R. G.; PALOMO, J. S. H.; GONCALVES, M. A. B.; REIS, I. C. F.; OLIVEIRA, L. G.; RIBEIRO, C. C.; ISOSAKI, M.; VIEIRA, L. P.; FELTRIM, M. I. Z.; MANOEL, L. A.; ABUD, K. C. O.; PASCHOTTO, D. R.; NEVES, I. L. I.; SENAHA, L. E.; GARCIA, A. C. C. N.; CIPRIANO, S. L.; SANTOS, V. C.; FERRAZ, A. S.; MOREIRA, A. E. L. C.; PAULO, A. R. S. A. De; DUQUE, A. M. P. C.; TRINDADE, E.; BACAL, F.; AULER JUNIOR, J. O. C.; ALMEIDA, D. R.
- Case Report: Dilated Cardiomyopathy in a Newborn, a Potential Association With SARS-COV-2(2021) AZEKA, Estela; ARSHAD, Adam; MARTINS, Cristiane; DOMINGUEZ, Anna Claudia; SIQUEIRA, Adailson; LOSS, Andre Silveira; JATENE, Marcelo; MIURA, NanaObjective: The objective of this study was to describe the clinical course of a newborn who developed dilated cardiomyopathy (DCM) after COVID-19 infection. Methods: We retrospectively assessed the clinical notes of a pediatric patient with decompensated heart failure and who was previously positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: A 23-day-old newborn presented with diarrhea, hypoactivity, tachypnea, and lethargy. The infant progressed to develop respiratory failure and required orotracheal intubation due to apnea. A nasopharyngeal swab tested positive for SARS-COV-2. An echocardiogram (ECHO) demonstrated severe left ventricular dysfunction. The patient was discharged after 18 days with furosemide and angiotensin-converting enzyme inhibitors. During the follow-up period, the infant had two episodes of decompensated heart failure, with evidence of DCM. Investigations for known causes of secondary DCM were negative. The infant was promptly referred for heart transplantation. Conclusion: Although rare, we have observed a case of DCM in a newborn following COVID-19 disease. DCM may be a complication following COVID-19 disease in newborns.
- I Diretriz de ressuscitação cardiopulmonar e cuidados cardiovasculares de emergência da Sociedade Brasileira de Cardiologia(2013) GONZALEZ, M. M.; TIMERMAN, S.; GIANOTTO-OLIVEIRA, R.; POLASTRI, T. F.; CANESIN, M. F.; SCHIMIDT, A.; SIQUEIRA, A. W.; PISPICO, A.; LONGO, A.; PIERI, A.; REIS, A.; TANAKA, A. C. S.; SANTOS, A. M.; QUILICI, A. P.; RIBEIRO, A. C. L.; BARRETO, A. C. P.; PAZIN-FILHO, A.; TIMERMAN, A.; MACHADO, C. A.; FRANCHIN NETO, C.; MIRANDA, C. H.; MEDEIROS, C. R.; MALAQUE, C. M. S.; BERNOCHE, C.; GONCALVES, D. M.; SANT'ANA, D. G.; OSAWA, E. A.; PEIXOTO, E.; ARFELLI, E.; EVARISTO, E. F.; AZEKA, E.; GOMES, E. P.; WEN, F. H.; FERREIRA, F. G.; LIMA, F. G.; MATTOS, F. R.; GALAS, F. G.; MARQUES, F. R. B.; TARASOUTCHI, F.; MANCUSO, F. J. N.; FREITAS, G. R.; FEITOSA-FILHO, G. S.; BARBOSA, G. C.; GIOVANINI, G. R.; MIOTTO, H. C.; GUIMARAES, H. P.; ANDRADE, J. P.; OLIVEIRA-FILHO, J.; FERNANDES, J. G.; MORAES JUNIOR, J. B. M. X.; CARVALHO, J. J. F.; RAMIRES, J. A. F.; CAVALINI, J. F.; TELES, J. M. M.; LOPES, J. L.; LOPES, L. N. G. D.; PIEGAS, L. S.; HAJJAR, L. A.; BRUNORIO, L.; DALLAN, L. A. P.; CARDOSO, L. F.; RABELO, M. M. N.; ALMEIDA, M. F. B.; SOUZA, M. F. S.; FAVARATO, M. H.; PAVAO, M. L. R. C.; SHIMODA, M. S.; OLIVEIRA JUNIOR, M. T.; MIURA, N.; FILGUEIRAS FILHO, N. M.; PONTES-NETO, O. M.; PINHEIRO, P. A. P. C.; FARSKY, O. S.; LOPES, R. D.; SILVA, R. C. G.; KALIL FILHO, R.; GONCALVES, R. M.; GAGLIARDI, R. J.; GUINSBURG, R.; LISAK, S.; ARAUJO, S.; MARTINS, S. C. O.; LAGE, S. G.; FRANCHI, S. M.; SHIMODA, T.; ACCORSI, T. D.; BARRAL, T. C. N.; MACHADO, T. A. O.; SCUDELER, T. L.; LIMA, V. C.; GUIMARAES, V. A.; SALLAI, V. S.; XAVIER, W. S.; NAZIMA, W.; SAKO, Y. K.
- I Diretriz Brasileira de cardio-oncologia Pediátrica da Sociedade Brasileira de Cardiologia(2013) SEBER, Adriana; MIACHON, Adriana Siviero; TANAKA, Ana Cristina Sayuri; CASTRO, Angela Maria Spinola e; CARVALHO, Antonio Carlos; PETRILLI, Antonio Sergio; MACEDO, Carla Renata Donato Pacheco; NARS, Clarissa Carvalho Fongaro; TERZIAN, Claudia Naufel; CASTRO JUNIOR, Claudio Galvao de; SANTOS, Cleusa Cavalcanti Lapa; GUERRA, Cristina Chaves dos Santos; SILVA, Dafne Cardoso Bourguignon da; BASSI, Debora Ugayama; AZEKA, Estela; FEITOSA, Fabiana Aragao; HAMAMOTO, Fernando; SZARF, Gilberto; LEDERMAN, Henrique Manoel; RIGON JUNIOR, Humberto Joao; JATENE, Ieda Biscegli; MOTA, Isabele Coelho Fonseca da; PERRUD, Jeferson Adriano; SOARES JUNIOR, Jose; GUTIERREZ, Julian Arango; PERIN, Juliana Pepe Marinho; SOARES, Juliana dos Santos; CATANI, Liane Hulle; TSAI, Liliana Yu; VIANNA, Livia Cristina; PAIVA, Marcelo Goulart; SANTOS, Marcelo Jose; ISHIGAI, Marcia Marcelino de Souza; DIOGENES, Maria Suely Bezerra; ALVES, Maria Teresa de Seixas; PIEDADE, Maria Tereza Castro; PARREIRAS, Mariana; CYPRIANO, Monica; NEGRINI, Nilce da Silva; CAMPOS FILHO, Orlando; FIGUEIREDO, Paula Andrade; NOVAES, Paulo Eduardo; CAMARGO, Paulo Roberto; MAIA, Priscila dos Santos; PETRILLI, Renata; ARDUINI, Rodrigo Genaro; GOUVEIA, Roseane Vasconcelos; TERUYA, Suzana Barbosa Miranda; MOISES, Valdir Ambrosio; MORAIS, Vera Lucia Lins de
- Clinical recommendations for postoperative care after heart transplantation in children: 21 years of a single-center experience(2014) AZEKA, Estela; JATENE, Marcelo Biscegli; TANAKA, Ana Cristina; GALAS, Filomena Regina; HAJJAR, Ludhmilla Abrahao; MIURA, Nana; AULER JUNIOR, Jose Otavio CostaHeart transplantation is an option for children with complex congenital heart disease and cardiomyopathies. A patient's quality of life and long-term survival depend on successful management of the surgical complications and adverse side effects of immunosuppression. The purpose of this review was to summarize the practical management of postoperative care in this patient population and to make recommendations for the future.