GUILHERME SOBREIRA SPINA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
conferenceObject PRIMARY TRICUSPID REGURGITATION AND PATENT FORAMEN OVALE: A RARE CAUSE OF HYPOXEMIA(2023) CARVALHO, Leticia Neves Solon; FERREIRA, Jose Carlos Lucena De Aguiar; NASCIMENTO, Andre Luiz Kummer Hora; POPP, Vinicius Oro; SPINA, Guilherme S.; CALDERARO, Daniela; TARASOUTCHI, Flavio- Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease(2021) LOPES, Mariana Pezzute; ROSA, Vitor Emer Egypto; PALMA, Jose Honorio; VIEIRA, Marcelo Luiz Campos; FERNANDES, Joao Ricardo Cordeiro; SANTIS, Antonio de; SPINA, Guilherme Sobreira; FONSECA, Rafael de Jesus; MARCHI, Mauricio F. de Sa; ABIZAID, Alexandre; BRITO, Fabio Sandoli de; TARASOUTCHI, Flavio; SAMPAIO, Roney Orismar; RIBEIRO, Henrique BarbosaBackground: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median followup of 20.7 [5.1-30.4] months, cumulative mortality was similar between both groups (p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30 day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.
conferenceObject Long-term prognostic impact of pulmonary vascular resistance in patients with rheumatic mitral stenosis undergoing percutaneous mitral balloon valvuloplasty(2022) NAZZETTA, D. Cian; SOUSA, L. C. G. De; ROSA, V. E. E.; TESSARI, F. C.; PESSOA, R. S.; LIPARI, L. F. V. P.; FERNANDES, J. R. C.; LOPES, M. P.; SANTIS, A. S. A. L. De; SPINA, G. S.; PIRES, L. J. N. T.; SAMPAIO, R. O.; TARASOUTCHI, F.- Rheumatic Myocarditis: A Poorly Recognized Etiology of Left Ventricular Dysfunction in Valvular Heart Disease Patients(2021) ROSA, Vitor Emer Egypto; LOPES, Mariana Pezzute; SPINA, Guilherme Sobreira; SOARES JUNIOR, Jose; SALAZAR, David; ROMERO, Cristhian Espinoza; LOTTENBERG, Marcos Pita; SANTIS, Antonio de; PIRES, Lucas Jose Neves Tachotti; GONCALVES, Luis Fernando Tonello; FERNANDES, Joao Ricardo Cordeiro; SAMPAIO, Roney Orismar; TARASOUTCHI, FlavioBackground: Heart failure occurs in similar to 10% of patients with acute rheumatic fever (RF), and several studies have shown that cardiac decompensation in RF results primarily from valvular disease and is not due to primary myocarditis. However, the literature on this topic is scarce, and a recent case series has shown that recurrent RF can cause ventricular dysfunction even in the absence of valvular heart disease. Methods: The present study evaluated the clinical, laboratory and imaging characteristics of 25 consecutive patients with a clinical diagnosis of myocarditis confirmed by 18F-FDG PET/CT or gallium-67 cardiac scintigraphy and RF reactivation according to the revised Jones Criteria. Patients underwent three sequential echocardiograms at (1) baseline, (2) during myocarditis and (3) post corticosteroid treatment. Patients were divided according to the presence (Group 1) or absence (Group 2) of reduced left ventricular ejection fraction (LVEF) during myocarditis episodes. Results: The median age was 42 (17-51) years, 64% of patients were older than 40 years, and 64% were women. Between Group 1 (n = 16) and in Group 2 (n = 9), there were no demographic, echocardiographic or laboratory differences except for NYHA III/IV heart failure (Group 1: 100.0% vs. Group 2: 50.0%; p = 0.012) and LVEF (30 [25-37] vs. 56 [49-62]%, respectively; p < 0.001), as expected. Group 1 patients showed a significant reduction in LVEF during carditis with further improvement after treatment. There was no correlation between LVEF and valvular dysfunction during myocarditis. Among all patients, 19 (76%) underwent 18F-FDG PET/CT, with a positive scan in 68.4%, and 21 (84%) underwent gallium-67 cardiac scintigraphy, with positive uptake in 95.2%, there was no difference between these groups. Conclusion: Myocarditis due to rheumatic fever reactivation can cause left ventricular dysfunction despite valvular disease, and it is reversible after corticosteroid treatment.
conferenceObject Aortic stenosis and inappropriate myocardial hypertrophy: is there a difference related to gender?(2019) BETTEGA, M.; ROSA, V. E. E. R.; ACCORSI, T. A. D. A.; FERNANDES, J. R. C. F. Cordeiro; SPINA, G. S. P.; SAMPAIO, R. O. S.; SANTIS, A. S. A. L.; TARASOUTCHI, F. T.- Incidental histological diagnosis of acute rheumatic myocarditis: case report and review of the literature(2014) SPINA, Guilherme S.; SAMPAIO, Roney O.; BRANCO, Carlos E.; MIRANDA, George B.; ROSA, Vitor E. E.; TARASOUTCHI, FlavioRheumatic fever (RF) remains endemic in many countries and frequently causes heart failure due to severe chronic rheumatic valvular heart disease, which requires surgical treatment. Here, we report on a patient who underwent an elective surgical correction for mitral and aortic valvular heart disease and had a post-operative diagnosis of acute rheumatic carditis. The incidental finding of Aschoff bodies in myocardial biopsies is frequently reported in the nineteenth-century literature, with prevalences as high as 35%, but no clinical or prognostic data on the patients is included. The high frequency of this finding after cardiac surgery in classical reports suggests that these patients were not using secondary prophylaxis for RE We discuss the clinical diagnosis of acute rheumatic myocarditis in asymptomatic patients and the laboratorial and imaging methods for the diagnosis of acute rheumatic carditis. We also discuss the prognostic implications of this finding and review the related literature.
- Gonococcal aortitis in a patient with fever of unknown origin (vol 48, pg 887, 2018)(2018) BERTOLLO, Leandro P. G.; D'ANGELO, Giovanna F.; SOARES JR., Jose; SPINA, Guilherme S.; SOUZA, Jean
conferenceObject Degenerative or rheumatic: after all, what is the most prevalent etiology of mitral regurgitation in developing countries?(2023) LIPARI, L. F. Vicente Pereira; FERNANDES, J. R. C.; ZIOTTI, S. V.; NAZZETTA, D. C.; TESSARI, F. C.; PESSOA, R. S.; HAUSSAUER JR., H. V.; ROSA, V. E. E.; PIRES, L. J. N. T.; ACCORSI, T. A. D.; LOPES, M. P.; SANTIS, A. S. De; SPINA, G. S.; SAMPAIO, R. O.; TARASOUTCHI, F.article Total surgical correction of Lutembacher syndrome associated with partial anomalous connection of the pulmonary veins and tricuspid regurgitation(2021) POMERANTZEFF, Pablo M. A.; BICHUETTE, Luciana D.; VERONESE, Elinthon T.; RODRIGUES, Renan C.; SPINA, Guilherme S.; JATENE, Fabio B.Lutembacher syndrome is characterized by the association of mitral stenosis and atrial septal defect (ASD), usually of the ostium secundum type. The association between superior vena cava-type ASD and partial anomalous pulmonary venous connection is unusual and there are few descriptions in the literature. We report this condition in a 24-year-old woman who was admitted to the hospital with a 1-year history of progressive dyspnea and describe the successful surgical repair following mitral commissurotomy and tunneling of the anomalous pulmonary veins to the left atrium, which determines the closure of the ASD and tricuspid repair.- Mitral re-valve-in-valve as a new perspective for high-risk patients with prosthetic valve dysfunction: case reports(2023) PIAZ, Matheus Ramos Dal; PIRES, Lucas Tachotti; HERRERA, Jonathan Cayo Urdiales; LABAT, Andre Luis Bezerra; CIVIDANES, Felipe Reale; SPINA, Guilherme Sobreira; PALMA, Jose Honorio; TARASOUTCHI, FlavioBackground Mitral valve diseases are a common medical condition, and surgery is the most used therapeutic approach. The need for less invasive interventions led to the development of transcatheter valve implantation in high-risk patients. However, the treatment to the dysfunctions of these prosthetic valves is still uncertain, and the yield and safety of repeated transcatheter valve implantations remain unclear.Cases summary A 69-year-old Caucasian woman with three previous mitral valve procedures performed due to rheumatic valve disease (currently with a biological prosthetic mitral valve) and a 76-year-old Latin woman with previous liver transplantation (due to metabolic-associated fatty liver disease) and biological mitral prosthesis due to mitral valve prolapse with severe regurgitation underwent mitral valve-in-valve (ViV) transcatheter implantation at the time of dysfunction of their surgical prostheses. Later, these patients developed prosthetic valve dysfunction and clinical worsening, requiring another invasive procedure. Due to maintained high-risk status and unfavourable clinical conditions for surgery, re-valve-in-valve (re-ViV) was performed.Discussion Valve-in-valve transcatheter mitral valve implantation was approved in 2017, and, since then, it has been used in several countries, mainly in high-risk patients. Nevertheless, these prosthetic valves may complicate with stenosis or regurgitation, demanding reinterventions. Although there are favourable data for mitral ViV, re-ViV still lacks robust data to support its performance, with only case reports in the literature so far. It is possible that in high-risk patients, there is a greater benefit from re-ViV when compared with the surgical strategy. However, this hypothesis must be studied in future controlled trials.