NANA MIURA IKARI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- Mechanical Circulatory Assistance in Children: Clinical Outcome(2023) CORBI, Maria Julia De Aro Braz; JATENE, Marcelo Biscegli; SIQUEIRA, Adailson Wagner Da Silva; GRAU, Claudia Regina Pinheiro Castro; TAVARES, Glaucia Maria Penha; IKARI, Nana Miura; AZEKA, EstelaBackground. In countries where organ donation is scarce, mortality in the pediatric heart transplant waiting list is high, and ventricular assist devices (VADs) are therapeutic alternatives in these situations. Berlin Heart EXCOR is currently 1 of the few VADs specific for children.Methods. This retrospective study includes pediatric patients who underwent Berlin Heart EXCOR placement in a Brazilian hospital between 2012 and 2021. Clinical and laboratory data at the time of VAD implantation and the occurrence of complications and outcomes (success as a bridge to transplant or death) were analyzed.Results. Eight patients, from 8 months to 15 years, were included: 6 with cardiomyopathy and 2 with congenital heart disease. Six were on Intermacs 1 and 2 on Intermacs 2. The most common complications observed were stroke and right ventricular dysfunction. Six were transplanted, and 2 died. Those submitted to transplant had a higher mean weight than those who died, with no statistically significant difference. The underlying disease had no impact on the outcome. The group undergoing transplant had lower brain natriuretic peptide and lactate values, but no laboratory variable showed a statistically significant difference in the outcome. Conclusion. A VAD is an invasive treatment with potentially serious adverse effects and is still poorly available in Brazil. However, as a bridge to transplant, it is a useful treatment for children in progressive clinical decline. In this study, we did not observe any clinical or laboratory factor at the time of VAD implantation that implied better outcomes.
- Implementation of a High-Risk Outpatient Clinic for Children with Complex Congenital Heart Disease in a Reference Service in Brazil(2023) FORONDA, Gustavo; MELO, Vanessa Ferreira Amorim de; GRAU, Claudia Regina Pinheiro de Castro; PIVA, Ingrid Magatti; TAVARES, Glaucia Maria Penha; TANAKA, Ana Cristina Sayuri; MIURA, NanaBackground: Children with congenital heart disease (CHD), even after surgical approaches, and especially those who undergo staged procedures in the first months of life, remain vulnerable to readmissions and complications, requiring very close monitoring and differentiated intervention strategies. Methods: Descriptive and exploratory study, of the experience report type, which presents the process of building the high -risk outpatient clinic for complex congenital heart diseases (AAR) at the Instituto do Coracao (InCor). Results: Report of the path taken to structure the AAR, demonstrating the organization, interface with the multidisciplinary team, admission and discharge criteria, training, and patient profile. In these five years of care, 275 patients were treated, 59.65% with biventricular interstage physiology, followed by univentricular interstage physiology (34.55%), residual defects after surgical procedures (3.63%), tumors with risk of mechanical obstruction ( 1.45%) and patients with an intrauterine approach (0.72%). The significant number of critical patients who were successfully discharged from hospital (44.72%), the low mortality rate due to sudden deaths at home and the high adherence to follow-up corroborate the impact of this specialized assistance. Conclusions: Despite the limitations of the study, this experience report showed that with few resources, there is the possibility of organizing an AAR with differentiated care, with the objective of early detection and treatment of residual injuries, identification of early interventions, education of parents for follow-up of their children, resulting in individualized treatment, promoting a better quality of life for this population.
- Heart Transplantation in Children and Adults With Congenital Heart Disease: 3 Decades of Evolution(2023) AZEKA, Estela; SIQUEIRA, Adailson Wagner Da Silva; TANAKA, Ana Cristina; MASSOTI, Maria Raquel Brigoni; MIANA, Leonardo; ZORZANELLI, Leina; GUIMARAES, Vanessa; PENHA, Juliano; CANEO, Luiz Fernando; TANAMATI, Carla; MIURA, Nana; JATENE, Marcelo BiscegliHeart transplantation is the treatment of choice for children and adults with congenital heart disease. We report the heart transplant single-center experience. The number of transplantations has increased over the last 3 decades. The Kaplan-Meier survival curves in the first, second, and third decades at 5 and 10 years were 69% and 59%, 62% and 52%, and 66% and 60%, respectively.
- Brain tuberculoma in pediatric heart transplant recipient(2023) OLIVEIRA, Pedro Carpini de; CORBI, Maria Julia de Aro Braz; SIQUEIRA, Adailson Wagner da Silva; NAVAJASEGARAN, Joshua; MESQUITA, Ana Sofia Silva; FRASSETTO, Fernando Pereira; JATENE, Marcelo Bisceglli; IKARI, Nana Miura; AZEKA, EstelaIntroductionHeart transplantation is the standard treatment for end-stage heart disease. Despite advances in the field, patients remain under risk of developing complications, including opportunistic infections, such as tuberculosis. We present the unprecedented case of cerebral tuberculoma in a 9-year-old heart transplant recipient. Case ScenarioA 9-year-old female child, who underwent heart transplantation in December 2020, was admitted to the emergency department in September 2021 due to headache and vomiting. She had normal vital signs and a mild left hemiparesis. Laboratory findings included lymphopenia and a low C Reactive Protein and brain images showed expansive lesions. A biopsy of the intracranial lesion was performed and anatomopathological analysis was compatible with tuberculoma. After the diagnosis was established, treatment protocol for neurotuberculosis was initiated, the patient had a satisfactory clinical evolution and was discharged 22 days after admission. DiscussionClinical manifestation of tuberculosis usually occurs up to 6 months after transplantation, the findings are commonly atypical and symptoms may be mild. We could not find in medical literature any description of the disease in a heart transplant recipient as young as the one presented in this case report. We documented great response to treatment, even though conventional antituberculosis therapy may interfere with immunosuppression. ConclusionPatients in the postoperative period following heart transplantation are at high risk for developing opportunistic infections such as tuberculosis, which may present with atypical symptoms. Therefore the clinician must have a high index of suspicion in order to make the correct diagnosis and promptly start treatment.
- Perinatal Results and Long-Term Follow-Up of Fetal Cardiac Tumors: A 30-Year Historical Cohort Study(2024) CAMARGO, Fabricio Marcondes; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli Vieira; CARVALHO, Werther Brunow de; IKARI, Nana Miura; PERES, Stella Verzinhasse; LOPES, Marco Antonio Borges; LOPES, Lilian MariaBackground: This was a 30-year retrospective cohort study that approximates closely to the natural history of cardiac tumors diagnosed in the fetus, since there was no case of pregnancy interruption Objective: To assess morbidity and mortality in the perinatal period and at long term in fetuses diagnosed with cardiac tumor. Our secondary objective was to assess the evaluating factors of perinatal and postnatal results. Methods: This was a retrospective cohort study with 74 pregnant women with an echocardiographic diagnosis of fetal cardiac tumor at two referral centers between May 1991 and November 2021. A descriptive analysis was performed, and data were expressed as absolute (n) and relative (%) frequencies, median and interquartile range. Fisher's exact test was used to evaluate the association of echocardiographic characteristics and clinical manifestations with perinatal and postnatal results. Global survival was calculated using the Kaplan-Meier method and the curves were compared by the log-rank test. The time of follow-up, calculated in months, corresponded to the time elapsed from hospital discharge to current status (survived/ censoring or death). The level of significance was set at 5% (p<0.05). Results: Rhabdomyoma is the most common type of cardiac tumor (85%), with a high morbidity (79.3%) and overall mortality of 17.4%. The presence of fetal hydrops was a predictor of death. Conclusion: The presence of fetal hydrops had an impact on mortality, and hence is an important factor in counselling and determining the prognosis. Most deaths occurred before hospital discharge.