ANTONIO AUGUSTO BARBOSA LOPES

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/31 - Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 23
  • article 3 Citação(ões) na Scopus
    Morphologic and immunohistochemical features of pulmonary vasculopathy in end-stage left ventricular systolic failure
    (2018) CAMPOS, Pompeu Tome Ribeiro de; LOPES, Antonio Augusto; ISSA, Victor Sali; AIELLO, Vera Demarchi
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    Circulating Levels of MIF, GRO alpha And RANTES Chemokines and Interleukin 17E Correlate With Severity of Pulmonary Hypertension in Young Pediatric Patients With Congenital Heart Disease
    (2015) ZORZANELLI, Leina; MAEDA, Nair Y.; CLEVE, Mariana M.; THOMAZ, Ana M.; RABINOVITCH, Marlene; LOPES, Antonio A.
  • article 5 Citação(ões) na Scopus
    Congenital heart disease and pulmonary arterial hypertension in South America
    (2014) LOPES, Antonio Augusto; FLORES, Patricia C.; DIAZ, Gabriel F.; MESQUITA, Sonia M. F.
    South America is a territory of 17,819,100 km(2), where similar to 388 million people live in 13 countries. In the region, access to medical assistance (e.g., for treatment of cardiovascular disorders) is relatively easy in metropolitan areas but difficult in remote places such as the Andes and the Amazon. Altitudes up to similar to 6,700 m influence the prevalence of congenital heart disease (CHD) and pulmonary arterial hypertension (PAH). In tertiary centers, CHD is now treated earlier in life but remains an important etiology of PAH. In adolescents and adults with PAH assisted at institutions devoted to treatment of cardiovascular disorders, the relative frequency of PAH-CHD (similar to 50%-60%) is even higher than that of idiopathic PAH. In one big tertiary center in Sao Paulo, Brazil, the prevalence of advanced PAH in children and adults with CHD is 1.2% and 4.2%, respectively. In young patients with cardiac septal defects (aged up to 2 years), pulmonary vascular abnormalities are a matter of concern in the decision about operability in 4.9% of cases. Access to specific PAH drugs is not uniform in South America, being unrealistic in remote places. In big cities, there are real possibilities for management of complex CHD, neonatal disorders, and even cardiac transplantation. Research activities have been implemented at clinical, translational, and basic levels. However, because of social and economic inequalities and political issues, access to best standards of medical care remains a problem in the region as a whole.
  • conferenceObject
    Increased Expression of Platelet Membrane Glycoprotein IIb/IIIa (GPIIb/IIIa) is Associated With Pulmonary Vasoreactivity After Pediatric Cardiac Surgery.
    (2018) MAEDA, Nair Y.; CLAVE, Mariana M.; CARVALHO, Eloisa S.; GALAS, Filomena R.; BYDLOWSKI, Sergio P.; LOPES, Antonio A.
  • article 12 Citação(ões) na Scopus
    Relation of Cytokine Profile to Clinical and Hemodynamic Features in Young Patients With Congenital Heart Disease and Pulmonary Hypertension
    (2017) ZORZANELLI, Leina; MAEDA, Nair; CLAVE, Mariana; THOMAZ, Ana; GALAS, Filomena; RABINOVITCH, Marlene; LOPES, Antonio
    In congenital heart disease, severity of pulmonary hypertension and operability is defined by noninvasive parameters (clinical history, physical examination, and echocardiography) and sometimes, cardiac catheterization. We investigated how circulating levels of inflammatory mediators correlate with such parameters in a young pediatric population (age, 2.0 months to 3.1 years) and the effects of preoperative pulmonary vasodilator therapy with sildenafil. Cytokines were analyzed in serum using chemiluminescence signals. In the whole patient group (n = 47), interleukin 17E, a Th2 immune response mediator increased with increasing age, considered as a parameter of disease severity (R-2 = 0.24, p <0.001), whereas the angiogenic chemokine growth-regulated oncogene alpha decreased (R-2 = 0.21, p = 0.001). Macrophage migration inhibitory factor chemokine was greater in subjects with elevated pulmonary vascular resistance (n = 16, p = 0.022), whereas regulated on activation, normal T cell expressed and secreted chemokine was greater in subjects with pulmonary congestion due to increased pulmonary blood flow (n = 31, p = 0.037). The observations were the same for the specific subpopulation of patients with Down syndrome (p = 0.009 and p = 0.012 for migration inhibitory factor and regulated on activation, normal T cell expressed and secreted in the respective subgroups). Sildenafil administration to patients with elevated pulmonary vascular resistance resulted in improvement of pulmonary blood flow (p = 0.012) and systemic oxygen saturation (p = 0.010), with a decrease in serum interleukin 6 (p = 0.027) and soluble ICAM-1 (p = 0.011). In conclusion, levels of circulating inflammatory molecules seem to correlate with disease severity in this population, with potential pathophysiological and therapeutic implications.
  • article 34 Citação(ões) na Scopus
    Myocarditis in children and detection of viruses in myocardial tissue: Implications for immunosuppressive therapy
    (2011) CAMARGO, Paulo Roberto; OKAY, Thelma Suely; YAMAMOTO, Lidia; NEGRO, Gilda Maria Barbaro Del; LOPES, Antonio Augusto
    Background: There is scarce information on the potential benefits of immunosuppression in children with myocarditis and viral genomes in myocardium. We investigated the occurrence of myocarditis in children with a preliminary diagnosis of dilated cardiomyopathy, the frequency of cardiotropic viruses in the myocardium, and the response to immunosuppression. Methods: Thirty patients (nine months to 12 years) with left ventricular ejection fraction of 22.8 +/- 4.1% were subjected to right cardiac catheterization and endomyocardial biopsy. Specimens were analyzed for the presence of inflammatory elements (Dallas criteria) and viral genome (polymerase chain reaction). Patients with active myocarditis received immunosuppressants (azatioprine and prednisone) and were recatheterized nine months later. A historical control group of nine patients with myocarditis who did not receive immunosuppressants was included. Results: Active myocarditis was diagnosed in ten patients (five with viral genomes detected). Immunosuppression resulted in a significant increase in left ventricular ejection fraction from 25.2 +/- 2.8% to 45.7 +/- 8.6% (versus 20.0 +/- 4.0% to 22.0 +/- 9.0% in historical controls, p < 0.01) and cardiac index from 3.28 +/- 0.51 L/min/m(2) to 4.40 +/- 0.49 L/min/m(2) (versus 3.50 +/- 0.40 L/min/m(2) to 3.70 +/- 0.50 L/min/m(2) in controls, p < 0.01), regardless of the presence of viral genomes (p - 0.98 and p - 0.22, respectively for the two variables). No relevant clinical events were observed. Non-inflammatory cardiomyopathy was diagnosed in 20 patients (seven with viral genomes). While on conventional therapy, there were four deaths and three assignments to transplantation, and no improvement of left ventricular ejection fraction in the remaining ones (22.5 +/- 3.6% to 27.5 +/- 10.6%). Conclusion: Children with chronic myocarditis seem to benefit from immunosuppressive therapy, regardless of the presence of viral genome in the myocardium.
  • article 5 Citação(ões) na Scopus
    Decreased circulating thrombomodulin is improved by tadalafil therapy in hypoxemic patients with advanced pulmonary arterial hypertension
    (2016) MAEDA, N. Y.; CLAVE, M. M.; BYDLOWSKI, S. P.; LOPES, A. A.
    Introduction: Advanced pulmonary arterial hypertension (PAH) in patients with congenital cardiac communications and right -to -left shunting (Eisenmenger syndrome - PAH-ES) is associated with hypoxemia and decreased circulating levels o{thrombomodulin (TM), probably reflecting decreased endothelial TM production. The combination of these two factors has been shown to induce fibrin deposition, with increased risk of thrombosis, a well known complication in this syndrome. Patients and methods: We tested the hypothesis that vasodilator therapy with the phosphocliesterase-5 inhibitor taclalafil, an approved drug for management of PAH could improve endothelial dysfunction markers, in particular plasma TM, in addition to improving the physical capacity (expected effect of pulmonary vasodilatation) in PAHES patients. This was a prospective observational study of treatment naive patients subjected to specific PAH therapy. Fifteen patients aged 12 to 51 years (median 30 years) were treated for 6 months with a single daily dose of 40 mg oral tadalafil. The physical capacity (distance walked during the 6 -min walk test - 6MWD), systemic oxygen saturation and laboratory parameters were measured at baseline, and 90 days and 180 days of treatment. Results: Plasma TM, which was decreased at baseline compared to controls (p < 0.001) increased at 90 and 180 days (p = 0.003), and this was directly related (r = 0.57, p = 0.026) to improvement of oxygen saturation (p = 0.008). Heightened baseline tissue -type plasminogen activator decreased during treatment (p = 0.010), while heightened von Willebrancl factor antigen remained unchanged. The 6MWD improved significantly (p < 0.001). Conclusion: Tadalafil therapy improved circulating TM and tissue -type plasminogen activator, in addition to improving the physical capacity and oxygen saturation in PAM ES patients. (C) 2016 Published by Elsevier Ltd.
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    Circulating Levels of RANTES Chemokine Correlate With Pulmonary Hemodynamic Patterns in Pediatric Patients With Congenital Cardiac Communications
    (2018) SOUZA, Maria F.; MAEDA, Nair Y.; CASTRO, Claudia R.; ZORZANELLI, Leina; CLAVE, Mariana M.; LOPES, Antonio A.
  • bookPart
    Cardiopatias congênitas com comunicações intra ou extracardíacas no paciente pediátrico
    (2016) LOPES, Antonio Augusto B.; BARRETO, Alessandra Costa; MOREIRA, Valéria de Melo; TAVARES, Glaucia Maria Penha