LUIZ JUNYA KAJITA
Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- 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
- 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 AugustoManagement 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.
- 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 AlvesIntroduction: 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.
- 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 AlvesCoronary 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.
- 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 AparecidoOBJECTIVE: 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.
- 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 AlvesBACKGROUND: 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.
- Oclusão de Comunicação Interventricular Pós-Infarto com Prótese Percutânea Cera(2012) RIBEIRO, Henrique Barbosa; BARACIOLI, Luciano Moreira; KAJITA, Luiz Junya; PINHEIRO, Martina Battistini; RIBEIRO, Expedito E.; NICOLAU, Jose Carlos
- Does Ad Hoc Coronary Intervention Reduce Radiation Exposure? Analysis of 568 Patients(2015) TRUFFA, Marcio A. M.; ALVES, Gustavo M. P.; BERNARDI, Fernando; ESTEVES FILHO, Antonio; RIBEIRO, Expedito; GALON, Micheli Z.; SPADARO, Andre; KAJITA, Luiz J.; ARRIETA, Raul; LEMOS, Pedro A.Background: Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention. Objective: To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure. Methods: The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated. Results: A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 +/- 70.7 Gycm(2), while the staged group, to 139.2 +/- 75.3 Gycm(2) (p < 0.001). Conclusion: Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.
- Relation of Macrophage Migration Inhibitory Factor to Pulmonary Hemodynamics and Vascular Structure and Carbamyl-Phosphate Synthetase I Genetic Variations in Pediatric Patients with Congenital Cardiac Shunts(2019) MAEDA, Nair Y.; AIELLO, Vera D.; SANTOS, Paulo C.; THOMAZ, Ana M.; KAJITA, Luiz J.; BYDLOWSKI, Sergio P.; LOPES, Antonio AugustoMacrophage migration inhibitory factor (MIF) plays an important pathophysiological role in pulmonary hypertension (PHT). Previously, we demonstrated that serum MIF is increased in pediatric PHT associated with congenital heart disease (CHD). In the present study, we determined possible associations between MIF levels, hemodynamic and histological parameters, and mitochondrial carbamyl-phosphate synthetase I (CPSI) T1405N polymorphism in a similar population. The asparagine 1405 variant (related to A alleles in the C-to-A transversion) has been shown to be advantageous in pediatric PHT compared to the threonine 1405 variant (C alleles). Forty-one patients were enrolled (aged 2-36 months) and subsequently divided into 2 groups after diagnostic evaluation: the high-pulmonary blood flow (high PBF) group (pulmonary-to-systemic blood flow ratio 2.58 (2.21-3.01), geometric mean with 95% CI) and the high-pulmonary vascular resistance (high PVR) group (pulmonary vascular resistance 6.12 (4.78-7.89) Wood unitsxm2). Serum MIF was measured using a chemiluminescence assay. The CPSI polymorphism was analyzed by polymerase chain reaction followed by high-resolution melting analysis. Medial hypertrophy of pulmonary arteries was assessed by the histological examination of biopsy specimens. Serum MIF was elevated in patients compared to controls (p=0.045), particularly in the high-PVR group (n=16) (p=0.022) and in subjects with the AC CPSI T1405N genotype (n=16) compared to those with the CC genotype (n=25) (p=0.017). Patients with high-PVR/AC-genotype profile (n=9) had the highest MIF levels (p=0.030 compared with the high-PBF/CC-genotype subgroup, n=18). In high-PVR/AC-genotype patients, the medial wall thickness of intra-acinar pulmonary arteries was directly related to MIF levels (p=0.033). There were no patients with the relatively rare AA genotype in the study population. Thus, in the advantageous scenario of the asparagine 1405 variant (AC heterozygosity in this study), heightened pulmonary vascular resistance in CHD-PHT is associated with medial hypertrophy of pulmonary arteries where MIF chemokine very likely plays a biological role.
- Efeitos Hemodinâmicos da Ventilação não Invasiva em Pacientes com Hipertensão Pulmonar Venocapilar(2014) BENTO, Andre Moreira; CARDOSO, Luiz Francisco; TARASOUTCHI, Flavio; SAMPAIO, Roney Orismar; KAJITA, Luiz Junya; LEMOS NETO, Pedro AlvesBackground: The hemodynamic effects of noninvasive ventilation with positive pressure in patients with pulmonary hypertension without left ventricular dysfunction are not clearly established. Objectives: Analyze the impact of increasing airway pressure with continuous positive airway pressure on hemodynamic parameters and, in particular, on cardiac output in patients with variable degrees of pulmonary hypertension. Methods: The study included 38 patients with pulmonary hypertension caused by mitral stenosis without left ventricular dysfunction or other significant valvulopathy. The hemodynamic state of these patients was analyzed in three conditions: baseline, after continuous positive pressure of 7 cmH(2)O and, finally, after pressure of 14 cmH(2)O. Results: The population was composed of predominantly young and female individuals with significant elevation in pulmonary arterial pressure (mean systolic pressure of 57 mmHg). Of all variables analyzed, only the right atrial pressure changed across the analyzed moments (from the baseline condition to the pressure of 14 cmH(2)O there was a change from 8 +/- 4 mmHg to 11 +/- 3 mmHg, respectively, p = 0.031). Even though there was no variation in mean cardiac output, increased values in pulmonary artery pressure were associated with increased cardiac output. There was no harmful effect or other clinical instability associated with use application of airway pressure. Conclusion: In patients with venocapillary pulmonary hypertension without left ventricular dysfunction, cardiac output response was directly associated with the degree of pulmonary hypertension. The application of noninvasive ventilation did not cause complications directly related to the ventilation systems.