JULIANO GOMES PENHA

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • conferenceObject
    PEDIATRIC HEART TRANSPLANTATION PROGRAM: SINGLE CENTER EXPERIENCE OF 20 YEARS
    (2013) AZEKA, Estela; GALAS, Filomena; TANAMATI, Carla; PENHA, Juliano; FERNANDES, Marcos; SENAHA, Luciano; XAVIER, Johnny; DELGADO, Ana Beatriz Romani; KAJITA, Luiz; AIELLO, Vera; BENVENUTI, Luiz; MIURA, Nana; AULER JUNIOR, Jose Otavio Costa; JATENE, Marcelo
    OBJECTIVE: Heart transplantation has been the treatment of choice for children with refractory to conventional therapy. To report the experience with heart transplantation in a single center. MATERIAL AND METHODS: To report the single center experience of hearttransplantation. Data analysis was demographic characteristics, clinical outcome and survival Kaplan Meier curve. RESULTS: From October 30, 1992 to October 2nd, 2012, 120 transplants were performed and 115 patients were submitted to heart transplantation at Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, Brazil. The causes of indication for transplantation were: cardiomyopathies (76%) and congenital heart disease (24%). Five patients were submitted to re-transplantation. Three of them were re-transplanted on the early postoperative period with high mortality (66.6%). One patient was submitted to simultaneous re-transplantation and kidney transplantation after 13.9 yrs of follow-up and one of patient was successful re-transplanted after 10 yr of follow-up. The post-operative immunosuppression regimen was double immunosuppression and polyclonal anti-thymocyte serum induction therapy. The actuarial survival was 80%, 71%, and 61% at 1, 5, and 10 yr, respectively. CONCLUSION: Heart transplantation has been a promising option for children. The use of double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide favorable clinical outcome.
  • article 2 Citação(ões) na Scopus
    Fontan postoperative complication: antegrade pulmonary flow
    (2011) TANAMATI, Carla; GUIMARAES, Vanessa Alves; PENHA, Juliano Gomes; BARBERO-MARCIAL, Miguel Lorenzo
  • article 3 Citação(ões) na Scopus
    Heart Transplantation in Pediatric Population and in Adults With Congenital Heart Disease: Long-term Follow-up, Critical Clinical Analysis, and Perspective for the Future
    (2014) AZEKA, E.; JATENE, M.; GALAS, F. R. B.; TANAMATI, C.; PENHA, J.; BENVENUTI, L.; MIURA, N.; JUNIOR, J. O. C.
    Background. Heart transplantation is a treatment option for children as well as for adults with congenital heart disease. Objective. To report the experience of a tertiary center with heart transplant program in pediatric population and in adults with congenital heart disease. Patients and Methods. The study consisted of the evaluation of pediatric as well as adult patients undergoing heart transplantation for congenital heart disease. We evaluated the following indication and complications such as renal dialysis, graft vascular disease, tumors and survival. Results. From October 1992 to November 2013, 134 patients had transplantation, and there were 139 transplantations and 5 retransplantations. The immunosuppression regimen is based on calcineurin inhibitors and cytostatic drugs. The type of heart disease indicated for transplantation was cardiomyopathies in 70% and congenital heart disease in 30%. Of these 134 patients, 85 patients were alive. Actuarial survival is 77.4%, 69.6%, 59.3% at 1, 5, and 10 years after transplantation. Three patients underwent renal transplantation, 1 patient is in renal dialysis, and 8.2% of patients had post-transplant lymphoproliferative disease. Two patients had retransplantation for graft vascular disease; 1 of them required a simultaneous kidney transplant and died 30 days after the procedure and 1 patient is clinically well 2 years after retransplantation. Conclusion. Heart transplantation in children and in adults with congenital heart disease is a promising therapeutic option and enables long-term survival for these patients.
  • article 2 Citação(ões) na Scopus
    Heart Retransplantation for Coronary Allograft Vasculopathy in Children: 25 Years of Single -Center Experience
    (2020) AZEKA, Estela; WALKER, Thomas; SIQUEIRA, Adailson Wagner da Silva; PENHA, Juliano; MIANA, Leonardo; CANEO, Luiz Fernando; MASSOTI, Maria Raquel; TANAMATI, Carla; MIURA, Nana; JATENE, Marcelo Biscegli
  • article
    Lessons Learned From a Critical Analysis of the Fontan Operation Over Three Decades in a Single Institution
    (2017) CANEO, Luiz Fernando; TURQUETTO, Aida L. R.; NEIROTTI, Rodolfo A.; BINOTTO, Maria A.; MIANA, Leonardo A.; TANAMATI, Carla; PENHA, Juliano G.; SILVEIRA, Joao B. D.; SILVA, Thais M. Alexandre e; JATENE, Fabio B.; JATENE, Marcelo B.
    Background: The Fontan operation (FO) has evolved and many centers have demonstrated improved results relative to those from earlier eras. We report a single-institution experience over three decades, describing the outcomes and evaluating risk factors. Methods: Successive patients undergoing primary FO were divided into era I (1984-1994), era II (1995-2004), and era III (2005-2014). Clinical and operative notes were reviewed for demographic, anatomic, and procedure details. End points included early and late mortality and a composite of death, heart transplantation (HTX), or Fontan takedown. Results: A total of 420 patients underwent 18 atriopulmonary connections, 82 lateral tunnels (LT), and 320 extracardiac conduit (EC) Fontan procedures. Forty-six (11%) patients died; early and late mortality were 7.9% and 3.1%, respectively. Eight (1.9%) patients underwent HTX, 11 (2.6%) underwent Fontan conversion to EC, and 1 (0.2%) takedown of EC to bidirectional Glenn shunt. Prevalence of concomitant valve surgery (P < .001) and pulmonary artery reconstruction (P < .001) differed over the eras. Preoperative valve regurgitation was associated with likelihood of early mortality (odds ratio [OR] = 3.5, P = .002). Embolic events (OR = 1.9, P = .047), preoperative valve regurgitation (OR = 2.3, P = .029), diagnosis of unbalanced atrioventricular canal defect (OR = 1.14, P = .03), and concomitant valve replacement (OR = 6.9, P = .001) during the FO were associated with increased risk of the composite end point (death, HTX, or takedown). Conclusion: Technical modifications did not result in improved results across eras, due in part to more liberal indications for surgery in the recent years. Valve regurgitation, unbalanced atrioventricular canal, embolic events, or concomitant valve replacement were associated with FO failure.
  • conferenceObject
    Waiting List Risk Factors in Pediatric Heart Transplant Center in the Developing Country
    (2012) CAUDURO, A. S.; MOREIRA, L. F. P.; TANAMATI, C.; CANEO, L. F.; PENHA, J.; JATENE, M. B.
    Purpose: Most of data upon waiting list risk factors are based in studies done in developed countries. In this study we aimed to identify what are these risk factors in a health system enviroment of a developing country like Brazil. Methods and Materials: Time on the waiting list was defined as the time of initial listing to the time of removal due a transplant, death, recovery or removed. Survival time in the waiting list was estimated using the Kaplan-Meier method. Univariate and multivariate relationships were evaluated with the Cox proportional hazards model. Results: Of 222 patients the median age was 3.9 yrs, median weight 13Kg; female 52%. Dilated cardiomyopathy 62%, congenital heart disease 25%, restrictive cardiomyopathy10%, chronic graft failure 3%. We had 45%listed as priority. 41% transplant, 40% died, 14% were removed, 5% are still waiting. Survival were 73% in 30 days, 60% in 90, 51% in 6m. Diagnosis, age, weight, urea, level and priorit status were considered predictors in the univariate analysis. Diagnosis of CHD and, priority status, were found as independent risk factors. Conclusions: Less has been known about the mortality risk factors in the waiting list in our enviroment. Actually these data are very similar to those ones retrieved in the early 1990 when the young and very ill children were destined to died. These results support the urgency of adoption of new technologies and new strategies addressed to child in the waiting list.
  • conferenceObject
    NEUROLOGICAL COMPLICATIONS AFTER PEDIATRIC HEART TRANSPLANTATION
    (2013) FERNANDES, Marcos; AZEKA, Estela; SENAHA, Luciano; DELGADO, Ana Beatriz Romani; GALAS, Filomena; GUIMARAES, Vanessa; HAJJAR, Ludmilha; TANAMATI, Carla; PENHA, Juliano; AULER JUNIOR, Jose Otavio Costa; JATENE, Marcelo
    OBJECTIVES: Neurological complications can occur after pediatric heart transplantation and its outcome may cause disabilities and limit the prognosis of children who have undergone this procedure. The aim of the study is to evaluate the neurological complications during the first 30 days after the heart transplantation. MATERIAL AND METHODS: A survey was made at based on the InCor records to find the data. RESULTS: From September 2011 to September 2012, 15 heart transplants were performed at the Heart Institute (InCor) University of Sao Paulo Medical School. The mean age was 11.1± yr5.34 yrs, median 9.63 yrs. There were 8 (53.3%) males. The diagnosis for heart transplantation was 80% cardiomiopathies. Two of them wereë. re-transplantation. One patient was with ECMO before transplantation and one was with assist device. Seven of them were priority when listed for the heart transplantation. The immunosuppression therapy was calcineurin inhibitor and cytostatic drug. Induction therapy was performed with antithymocyte globulin. Eight (53%) of 15 patients developed neurological complications. The main cause were strokes in 37.5%. The other causes were anisocoria in 1 (12%) patient, ischemic vascular accident 1 (12%) patient, hemorrhagic vascular accident 1 (12%). Three (20%) of them died due to multiple organ failure and infection, two of them were in priority before transplant (one with assist device) and were intubated with renal failure and sedated. These two patients were the ones that showed the worse neurological complications after the transplant. CONCLUSION: Neurological complications were common after heart transplantation, patient can have favorable clinical outcome after treatment.
  • article 3 Citação(ões) na Scopus
    Postoperative Pulmonary Hemodynamics and Systemic Inflammatory Response in Pediatric Patients Undergoing Surgery for Congenital Heart Defects
    (2022) SOUZA, Maria Francilene S.; PENHA, Juliano G.; MAEDA, Nair Y.; GALAS, Filomena R. B. G.; ABUD, Kelly C. O.; CARVALHO, Eloisa S.; THOMAZ, Ana Maria; CASTRO, Claudia R. P.; PEREIRA, Juliana; LOPES, Antonio Augusto
    There is scarce information about the relationships between postoperative pulmonary hemodynamics, inflammation, and outcomes in pediatric patients with congenital cardiac communications undergoing surgery. We prospectively studied 40 patients aged 11 (8-17) months (median with interquartile range) with a preoperative mean pulmonary arterial pressure of 48 (34-54) mmHg who were considered to be at risk for postoperative pulmonary hypertension. The immediate postoperative pulmonary/systemic mean arterial pressure ratio (PAP/SAP(IPO), mean of first 4 values obtained in the intensive care unit, readings at 2-hour intervals) was correlated directly with PAP/SAP registered in the surgical room just after cardiopulmonary bypass (r=0.68, p < 0.001). For the entire cohort, circulating levels of 15 inflammatory markers changed after surgery. Compared with patients with PAP/SAP(IPO)& LE;0.40 (n=22), those above this level (n=18) had increased pre- and postoperative serum levels of granulocyte colony-stimulating factor (p=0.040), interleukin-1 receptor antagonist (p=0.020), interleukin-6 (p=0.003), and interleukin-21 (p=0.047) (panel for 36 human cytokines) and increased mean platelet volume (p=0.018). Using logistic regression analysis, a PAP/SAP(IPO)> 0.40 and a heightened immediate postoperative serum level of macrophage migration inhibitory factor (quartile analysis) were shown to be predictive of significant postoperative cardiopulmonary events (respective hazard ratios with 95% CIs, 5.07 (1.10-23.45), and 3.29 (1.38-7.88)). Thus, the early postoperative behavior of the pulmonary circulation and systemic inflammatory response are closely related and can be used to predict outcomes in this population.
  • article 7 Citação(ões) na Scopus
    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 Biscegli
    Background: 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.
  • article 8 Citação(ões) na Scopus
    Heart Neoplasms in Children: Retrospective Analysis
    (2013) PENHA, Juliano Gomes; ZORZANELLI, Leina; BARBOSA-LOPES, Antonio Augusto; AIELLO, Vera Demarchi; CARVALHO, Vitor Oliveira; CANEO, Luiz Fernando; RISO, Arlindo de Almeida; TANAMATI, Carla; ATIK, Edimar; JATENE, Marcelo Biscegli
    Background: The advancement of noninvasive imaging methods has resulted in the increase in diagnosis of heart neoplasms. However, the literature has few studies involving primary cardiac neoplasms in children. Objective: To retrospectively review cases of primary heart neoplasms in children, considering the initial clinical manifestations, diagnostic tests used, surgical indication, histopathological types and immediate postoperative course. Methods: The retrospective study was based on the assessment of medical records from 1983 to 2011. Only cases that were referred for surgical treatment during that period were included. Age at admission, prenatal diagnosis, family history, initial symptoms and the results of performed tests were assessed. Moreover, the date and indication of the surgery, intraoperative findings, the result of the histopathological analysis, as well as the immediate postoperative complications were recorded. Results: Of the 18 patients studied, the most frequent clinical manifestations were dyspnea and heart murmur (7 and 6 patients, respectively); the most often used adjunct diagnostic method was echocardiography (18 patients); cavitary obstruction or ventricular inflow or outflow tract obstruction was the main indication for surgery (12 cases); the most common histological profile was rhabdomyoma (7 patients) and most patients showed good clinical outcome. Conclusion: In this study, imaging diagnosis was basically attained through echocardiography, with good correlation with intraoperative findings. Histopathological findings were consistent with the literature, with rhabdomyoma being the most common neoplasm in children. The evolution after surgical treatment was favorable in most cases. (Arq Bras Cardiol. 2013; 100(2): 120-126)