LUIZ JUNYA KAJITA

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 28
  • 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 1 Citação(ões) na Scopus
    Cardiac Catheterization in a Patient with Obstructive Hypertrophic Cardiomyopathy and Syncope
    (2017) NUNES, Rafael Amorim Belo; RIBEIRO, Henrique Barbosa; KAJITA, Luiz Junya; GAIOTTO, Fabio Antonio
  • article 8 Citação(ões) na Scopus
    Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments
    (2019) THOMAZ, Ana Maria; KAJITA, Luiz J.; AIELLO, Vera D.; ZORZANELLI, Leina; GALAS, Filomena Regina B. G.; MACHADO, Cleide G.; BARBERO-MARCIAL, Miguel; JATENE, Marcelo B.; RABINOVITCH, Marlene; LOPES, Antonio Augusto
    Management of pediatric pulmonary hypertension associated with congenital heart disease (PHT-CHD) is challenging. Some patients have persistently elevated pulmonary artery pressure (PAP) after cardiac surgery, an undesired condition that is difficult to predict. We investigated the value of clinical, hemodynamic, and histopathological data in predicting the outcome in a prospective cohort. Patients with PHT-CHD received sildenafil orally pre- and postoperatively for six months and then were subjected to a catheter study. Thirty-three patients were enrolled (age range = 4.6-37.0 months). Pulmonary vascular resistance (PVR) was 4.9 (range = 3.9-7.2) Wood units x m(2) (median with IQR). Twenty-two patients had a >= 20% decrease in PVR and pulmonary-to-systemic vascular resistance ratio (PVR/SVR) in response to inhaled nitric oxide (NO). The response was directly related to the degree of medial hypertrophy of pulmonary arterioles (P < 0.05) (morphometric analysis, intraoperative lung biopsy). Subsequently, five of the non-responders had a >= 30% increase in pulmonary blood flow in response to sildenafil (3.0 [2.0-4.0] mg/kg/day). Six months after surgery, PAP and PVR were significantly lower (P < 0.001 vs. baseline), even in seven patients with Heath-Edwards grade III/IV pulmonary vascular lesions (P = 0.018), but still abnormal in 12 individuals (>25 mmHg and >3.0 U x m(2), respectively). A preoperative PVR/SVR of >= 24% during NO inhalation and a wall thickness of arteries accompanying respiratory bronchioli of >= 4.7 (Z score) were identified, respectively, as risk and protection factors for abnormal postoperative hemodynamics (hazard ratio [95% CI] = 1.09 [1.01-1.18], P = 0.036; and 0.69 [0.49-0.98], P = 0.040, respectively). Thus, in PHT-CHD patients receiving oral sildenafil pre- and post-surgical repair of cardiac lesions, mid-term postoperative outcome is predictable to some extent.
  • article 3 Citação(ões) na Scopus
    Remoção Precoce do Introdutor Arterial Após Intervenção Coronária Percutânea por Via Femoral: Estudo de Segurança e Eficácia
    (2014) ZAGO, Gabriel; TRENTIN, Fabio; PRADO JR., Guy F. A.; SPADARO, Andre Gasparini; SILVA, Expedito Eustáquio Ribeiro da; CAMPOS, Carlos Magalhães; PERIN, Marco Antonio; FALCÃO, Breno de Alencar Araripe; ESTEVES-FILHO, Antonio; KAJITA, Luiz Junya; GAMA, Marcus Nogueira da; MARCHIORI, Gilberto; HORTA, Pedro Eduardo; TAKIMURA, Celso Kiyochi; MARIANI JR., Jose; GALON, Micheli Zanotti; SOARES, Paulo Rogerio; ZALC, Silvio; KALIL-FILHO, Roberto; LEMOS NETO, Pedro Alves
    Introduction: We evaluated the safety and efficacy of protamine administration, guided by activated clotting time, for the immediate femoral arterial sheath removal in patients undergoing percutaneous coronary intervention with unfractionated heparin in order to propose an algorithm for clinical practice. Methods: Prospective study with consecutive patients with stable angina or low-to-moderate risk acute coronary syndrome. We compared patients with an early removal of the arterial sheath to those whose sheath removal was based on a standard protocol. Results: The early removal group (n = 149) had lower access manipulation time than the conventional group (58.3 ± 21.4 minutes vs. 355.0 ± 62.9 minutes; p < 0.01), mainly due to a reduced time to sheath removal (42.3 ± 21.1 minutes vs. 338.6 ± 61.5 minutes; p < 0.01), with no impact on the duration of femoral compression (16.0 ± 3.6 minutes vs. 16.4 ± 5.1 minutes; p = 0.49). There was no stent thrombosis during hospitalization and no significant differences in the incidence of major vascular or bleeding events. The incidence of other bleeding events leading to a prolonged in-hospital length of stay was lower in the early removal group (1.3% vs. 5.1%; p = 0.05). Conclusions: The selective use of an approach for immediate femoral sheath removal, based on activated clotting time guidance and protamine administration, is a safe and effective option in patients undergoing percutaneous coronary intervention by femoral access.
  • conferenceObject
    CLINICAL CHALLENGES AFTER PEDIATRIC HEART TRANSPLANTATION: 20 YEARS OF EXPERIENCE
    (2013) AZEKA, Estela; AULER, Jose Otavio; GALAS, Filomena; TANAMATI, Carla; PENHA, Juliano; KAJITA, Luiz; AIELLO, Vera; BENVENUTI, Luiz; JATENE, Marcelo
    PURPOSE: Heart transplantation has been the treatment of choice for children with refractory to conventional therapy. Objective: to report the clinical experience with heart transplantation in a single center. METHOD: To report the single center experience of heart transplantation. 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 years of follow-up and one of patient was successful re-transplanted after 10 year 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
    Type 4 Dual Left Anterior Descending Artery: A Very Rare Coronary Anomaly Circulation
    (2015) OLIVEIRA, Marcos Danillo Peixoto; MELO, Pedro H. M. Craveiro de; ESTEVES FILHO, Antonio; KAJITA, Luiz J.; RIBEIRO, Expedito E.; LEMOS, Pedro Alves
    Coronary artery anomalies are congenital changes in their origin, course, and/or structure. They are the second most frequent cause of sudden death in young athletes. Dual LAD artery is a rare coronary anomaly. We present the case of a 44-year-old man with recent onset exertional angina and documented ischemia whose coronary angiogramand computed tomography (CT) showed type 4 dual LAD artery, the rarest and most interesting variant.
  • article 0 Citação(ões) na Scopus
    Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography
    (2017) MACEDO, Thiago Andrade; DRAGER, Luciano Ferreira; PEDROSA, Rodrigo Pinto; MUELA, Henrique Cotchi Simbo; COSTA-HONG, Valeria; KAJITA, Luiz Junia; BORTOLOTTO, Luiz Aparecido
    OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63 +/- 12 vs 56 +/- 12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis >= 70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (>= 70%) in patients clinically suspected of having renovascular hypertension.
  • article 1 Citação(ões) na Scopus
    Direct communication between the left circumflex and the right coronary arteries: a very rare coronary anomaly circulation
    (2016) OLIVEIRA, Marcos Danillo Peixoto; CAVALCANTI, Rafael R. Cesar; KAJITA, Alexandre H.; MIRANDA, Thais; KAJITA, Luiz J.; HORTA, Pedro E.; RIBEIRO, Expedito E.; LEMOS, Pedro Alves
    Coronary artery anomalies (CAA) are congenital changes in their origin, course, and/or structure. Intercoronary communication (ICC) is a very rare subset with uni-or bidirectional blood flow between two or more coronary arteries. We present the case of a 58-year-old man with an acute coronary syndrome whose coronary angiography incidentally showed a surprising and very rare communication between the right coronary and left circumflex arteries.
  • article 0 Citação(ões) na Scopus
    Valvuloplastia aórtica por cateter balão na estenose aórtica degenerativa: impacto terapêutico em pacientes em condição clínica in extremis
    (2013) VAHLE, Vitor de Andrade; PINTON, Fábio Augusto; MELO, Eduardo França Pessoa de; BEZERRA, Cristiano Guedes; PERIN, Marco Antônio; ARRIETA, Santiago Raul; KAJITA, Luiz Junya; MARIANI JUNIOR, José; ESTEVES FILHO, Antônio; SILVA, Expedito Eustáquio Ribeiro da; TARASOUTCHI, Flávio; GRINBERG, Max; LEMOS NETO, Pedro Alves
    BACKGROUND: Balloon aortic valvuloplasty (BAV) is used as a palliative strategy in patients who are not eligible for valve replacement surgery, transcatheter aortic valve implantation, or as a bridge to these treatment modalities. The impact of BAV as a salvage procedure for patients in extreme clinical conditions (in extremis) is unknown. METHODS: Patients with severe degenerative aortic stenosis undergoing BAV between July 2008 and January 2013 were evaluated. Patients were divided into the in-extremis group (defined by the presence of two or more of the following organ dysfunctions: mechanical ventilation, hemodynamic instability, dialysis, coagulopathy or severe hepatic dysfunction) and the control group, which included the remaining patients. RESULTS: A total of 19 patients underwent BAV. The clinical condition in-extremis was present in 42.1% of them. Patients from the in-extremis group had a higher EUROSCORE II (41.1 ± 24.7 vs. 15.9 ± 14.0; P = 0.001) and LV ejection fraction lower than the control group (33.9 ± 17.3% vs. 49.0 ± 12.5; P = 0.04). None of the patients in the in-extremis group survived past the hospitalization period, whereas the control group mortality was 27.3% (P < 0.01). CONCLUSIONS: BAV has an unfavorable result in patients with severe degenerative aortic stenosis with two or more organ dysfunctions, that is, patients in extremis.
  • article 18 Citação(ões) na Scopus
    Residual aortic regurgitation is a major determinant of late mortality after transcatheter aortic valve implantation
    (2012) LEMOS, Pedro A.; SAIA, Francesco; MARIANI JR., Jose; MARROZZINI, Cinzia; ESTEVES FILHO, Antonio; KAJITA, Luiz J.; CIUCA, Cristina; TAGLIERI, Nevio; BORDONI, Barbara; MORETTI, Carolina; PALMERINI, Tullio; DRACOULAKIS, Marianna D. A.; JATENE, Fabio B.; KALIL-FILHO, Roberto; MARZOCCHI, Antonio