VANESSA ALVES GUIMARAES BORGES

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

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Agora exibindo 1 - 10 de 14
  • bookPart
    Insuficiência cardíaca congestiva e transplante cardíaco na criança
    (2016) AZEKA, Estela; RIBEIRO, Anna Christina; THOMAZ, Ana Maria; GUIMARãES, Vanessa; GALAS, Filomena Regina; HOROWITZ, Estela; SIQUEIRA, Adailson; BENVENUTI, Luiz; ZORZANELLI, Leina; JATENE, Marcelo
  • 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
  • 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 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 1 Citação(ões) na Scopus
    Nomograms using a small panel of genes for predicting the diagnosis and aggressiveness of prostate cancer
    (2020) LEITE, Katia R. M.; ORTEGA, Fabio L.; DAMIANI, Lucas P.; GUIMARAES, Vanessa; VIANA, Nayara; SILVA, Iran A.; REIS, Sabrina T.; PIMENTA, Ruan; ADONIAS, Sanarelly P.; CHAMMAS, Cristina; SROUGI, Miguel; NAHAS, Willian
  • article 0 Citação(ões) na Scopus
    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 Biscegli
    Heart 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.
  • article 0 Citação(ões) na Scopus
    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.
  • article 16 Citação(ões) na Scopus
    Post-cardiotomy ECMO in pediatric and congenital heart surgery: impact of team training and equipment in the results
    (2015) MIANA, Leonardo Augusto; CANEO, Luiz Fernando; TANAMATI, Carla; PENHA, Juliano Gomes; GUIMARAES, Vanessa Alves; MIURA, Nana; GALAS, Filomena Regina Barbosa Gomes; JATENE, Marcelo Biscegli
    Introduction: Post-cardiotomy myocardial dysfunction requiring mechanical circulatory support occurs in about 0.5% of cases. In our environment, the use of extracorporeal membrane oxygenation has been increasing in recent years. Objective: To evaluate the impact of investment in professional training and improvement of equipment in the rate of weaning from extracorporeal membrane oxygenation and survival. Methods: A retrospective study. Fifty-six pediatric and/or congenital heart patients underwent post-cardiotomy extracorporeal membrane oxygenation at our institution between November 1999 and July 2014. We divided this period into two phases: phase I, 36 cases (before the structuring of the extra-corporeal membrane oxygenation program) and phase II, 20 cases (after the extracorporeal membrane oxygenation program implementation) with investment in training and equipment). Were considered as primary outcomes: extracorporeal membrane oxygenation weaning and survival to hospital discharge. The results in both phases were compared using Chi-square test. To identify the impact of the different variables we used binary logistic regression analysis. Results: Groups were comparable. In phase I, 9 patients (25%) were weaned from extracorporeal membrane oxygenation, but only 2 (5.5%) were discharged. In phase II, extracorporeal membrane oxygenation was used in 20 patients, weaning was possible in 17 (85%), with 9 (45%) hospital discharges (P<0.01). When the impact of several variables on discharge and weaning of extracorporeal membrane oxygenation was analyzed, we observe that phase II was an independent predictor of better results (P<0.001) and need for left cavities drainage was associated with worse survival (P=0.045). Conclusion: The investment in professional training and improvement of equipment significantly increased extracorporeal membrane oxygenation results.
  • article 0 Citação(ões) na Scopus
    Prediction of Pulmonary Arterial Pressure Level after Repair of Congenital Cardiac Communications and Discharge from the Hospital: Role of Down Syndrome and Early Postoperative Hemodynamics
    (2022) CARVALHO, Eloisa Sassa; SOUZA, Maria Francilene S.; ABUD, Kelly Cristina O.; CASTRO, Claudia R. P.; PENHA, Juliano G.; THOMAZ, Ana Maria; GUIMARAES, Vanessa A.; LOPES, Antonio Augusto
    Background: Postoperative pulmonary hypertension limits the success of surgical treatment in some patients with unrestrictive congenital cardiac communications. Identifying patients at risk of developing postoperative pulmonary hypertension is important to individualize follow-up strategies. Methods: We analyzed a prospective cohort of 52 pediatric patients (age 3 to 35 months) looking for perioperative predictors of mildly elevated pulmonary arterial pressure 6 months after surgery, defined as a systolic pressure greater than 30 mmHg by transthoracic echocardiography. This corresponds to a mean pulmonary arterial pressure of >20 mmHg. Clinical, echocardiographic and hemodynamic parameters were investigated. Perioperative hemodynamics was assessed by directly measuring pulmonary and systemic arterial pressures using indwelling catheters. Early postoperative pulmonary hemodynamics was defined as the mean pulmonary/systemic mean arterial pressure ratio (PAP/SAP) obtained per patient during the first 6 h of postoperative care. Results: Among the factors that were investigated as possible predictors, perioperative hemodynamics and the presence of Down syndrome were initially selected using univariate analysis (p < 0.030). Early postoperative PAP/SAP was correlated with PAP/SAP obtained in the operating room just after cardiopulmonary bypass (r = 0.70, p < 0.001), and it was higher in subjects with Down syndrome than in nonsyndromic individuals (p = 0.003). Early postoperative PAP/SAP was the only predictor selected using multivariate analysis. It was characterized as an independent predictor after adjustments for possible confounders. An early postoperative PAP/SAP of >0.35 was 76% sensitive and 74% specific at predicting a systolic pulmonary arterial pressure of >30 mmHg 6 months after surgery (hazard ratio with 95% CI 8.972 [2.428-33.158], p = 0.002). Conclusion: The hypertensive early postoperative behavior of the pulmonary circulation was strongly but not exclusively associated with Down syndrome, and it was characterized as an independent predictor of altered pulmonary arterial pressure after discharge from the hospital.
  • article 69 Citação(ões) na Scopus
    Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: A randomized pilot trial
    (2014) GALAS, Filomena R. B. G.; ALMEIDA, Juliano P. de; FUKUSHIMA, Julia T.; VINCENT, Jean Louis; OSAWA, Eduardo A.; ZEFERINO, Suely; CAMARA, Ligia; GUIMARAES, Vanessa A.; JATENE, Marcelo B.; HAJJAR, Ludhmila A.
    Objectives: Acute acquired hypofibrinogenemia in children undergoing cardiac surgery is a major concern because it often results in perioperative bleeding and high rates of allogeneic blood transfusion. Fibrinogen concentrate has been proposed as an alternative to cryoprecipitate (the gold standard therapy), with minimal infectious and immunologic risks. Our objective was to investigate the efficacy and safety of fibrinogen concentrate in children undergoing cardiac surgery. Methods: In this randomized pilot study, patients were allocated to receive fibrinogen concentrate (60 mg/kg) or cryoprecipitate (10 mL/kg) if bleeding was associated with fibrinogen levels <1 g/dL after cardiopulmonary bypass weaning. The primary outcome was postoperative blood losses during the 48 hours after surgery. Results: A total of 63 patients were included in the study, 30 in the fibrinogen concentrate group and 33 in the cryoprecipitate group. The median 48-hour blood loss was not significantly different between the 2 groups (320 mL [interquartile range, 157-750] vs 410 mL [interquartile range, 215-510], respectively; P = .672). After treatment, plasma fibrinogen concentration increased similarly following administration of both products. There were no differences in allogeneic blood transfusion after intervention treatment. Conclusions: A large trial comparing fibrinogen concentrate and cryoprecipitate in the management of children with acute acquired hypofibrinogenemia during heart surgery is feasible. The preliminary results of our study showed that the use of fibrinogen concentrate was as efficient and safe as cryoprecipitate in the management of bleeding children undergoing cardiac surgery.