FRANCISCA ALEXANDRA GAVILANES OLEAS

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LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 17 Citação(ões) na Scopus
    Disfunção ventricular esquerda em pacientes com suspeita de hipertensão arterial pulmonar
    (2014) GAVILANES, Francisca; ALVES JR., Jose Leonidas; FERNANDES, Caio; PRADA, Luis Felipe Lopes; JARDIM, Carlos Viana Poyares; MORINAGA, Luciana Tamie Kato; DIAS, Bruno Arantes; HOETTE, Susana; SOUZA, Rogerio
    Objective: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH). Methods: We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH-in the absence of severe left ventricular dysfunction (LVD), significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism between 2008 and 2013 at our facility. Results: During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH) was confirmed in 302 patients (78.6%). The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3% and 178 (81.7%) were diagnosed with PH associated with LVD (PH-LVD) and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001). Conclusions: The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant.
  • article 9 Citação(ões) na Scopus
    Use of medical therapies before pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients with severe hemodynamic impairment
    (2020) CASTRO, Marcela Araujo; PILOTO, Bruna; FERNANDES, Caio Julio Cesar dos Santos; JARDIM, Carlos; SALIBE FILHO, William; OLEAS, Francisca Gavilanes; ALVES, Jose Leonidas; MORINAGA, Luciana Tamie Kato; HOETTE, Susana; TERRA FILHO, Mario; FREITAS FILHO, Orival; JATENE, Fabio Biscegli; SOUZA, Rogerio
    Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, characterized by non-resolving fibro-thrombotic obstructions of large pulmonary arteries. Pulmonary endarterectomy (PEA) is the treatment of choice for the disease, significantly improving survival. Patients with worse hemodynamic profile have worse prognosis after surgery, raising the question of whether the use of medical therapy prior to surgery to optimize hemodynamics could improve outcomes. The aim of this study was to evaluate the role of medical therapy pre-PEA, according to the hemodynamic profile at the diagnosis. We retrospectively analyzed all patients submitted to PEA, from January 2013 to December 2017. Functional, clinical and hemodynamic data were collected to evaluate the main prognostic determinants. Patients were stratified according to the hemodynamic severity and use of targeted therapies prior to surgery. A total of 108 patients were included. Thirty-five patients (32,4%) used targeted therapy pre-PEA. The use of medical therapy delayed the surgical procedure by about 7 months. There was no difference in overall survival between patients that received targeted therapy and those treated only with supportive therapy (87.8% vs 80.3%, respectively, p = 0.426). Nevertheless, when analyzing the group of patients with severe hemodynamic impairment, defined by low cardiac output(< 3.7L/min) at baseline, patients treated with targeted therapies presented a significantly better one-year survival. In higher-risk CTEPH patients, characterized by the presence of low cardiac output, the use of targeted therapies prior to PEA was associated with better outcome, suggesting a potential role for pre-operative use of medical treatment in this particular subgroup.
  • article 2 Citação(ões) na Scopus
  • conferenceObject
    Cavities Lesions In Patients With Chronic Thromboembolic Pulmonary Hypertention
    (2017) OLIVEIRA, E. P.; FERNANDES, C. C.; OLEAS, F. G.; ALVES JUNIOR, J. L.; ATHANAZIO, R. A.; SALES, R. K. B.; MORAIS, I. O.; SALIBE FILHO, W.; JARDIM, C. V. P.; TERRA FILHO, M.; SOUZA, R.
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    The use of new anticoagulants in CTEPH
    (2017) GAVILANES, Francisca; ALVES JR., Jose Leonnidas; FERNANDES, Caio J. C.; PRADA, Luis F. L.; SALIBE FILHO, William; TERRA FILHO, Mario; JARDIM, Carlos; SOUZA, Rogerio
  • article 13 Citação(ões) na Scopus
    Pulmonary artery enlargement in schistosomiasis associated pulmonary arterial hypertension
    (2015) HOETTE, Susana; FIGUEIREDO, Claudia; DIAS, Bruno; ALVES- JR., Jose Leonidas; GAVILANES, Francisca; PRADA, Luis Felipe; JASINOWODOLINSKI, Dany; MORINAGA, Luciana Tamie Kato; JARDIM, Carlos; FERNANDES, Caio Julio Cesar; SOUZA, Rogerio
    Background: Schistosomiasis associated pulmonary arterial hypertension (Sch-PAH) might represent the most prevalent form of PAH worldwide. In Sch-PAH, the presence of aneurismal dilation of the pulmonary artery has been described, although it is still a matter of debate whether on average the pulmonary artery is more enlarged in Sc-PAH than IPAH. Methods: We retrospectively evaluated patients with IPAH (n = 25) and Sch-PAH (n = 22) who underwent computed tomography pulmonary angiogram and right heart catheterization. Results: Sch-PAH patients were older and presented less severe hemodynamic profiles. Main pulmonary artery diameter (MPAD) was greater in Sch-PAH than IPAH (4.5 +/- 1.8 vs 3.7 +/- 1.1 cm, p = 0.018). For the same level of mean pulmonary artery pressure, the MPAD in Sch-PAH was 0.89 cm larger than in IPAH (Covariance model p = 0.02). Conclusion: This study demonstrated that pulmonary artery enlargement is more pronounced in Sch-PAH than IPAH, independently of mean pulmonary artery pressure level, suggesting that this is more likely a feature of Sch-PAH.
  • article 10 Citação(ões) na Scopus
    Reperfusion in acute pulmonary thromboembolism
    (2018) FERNANDES, Caio Julio Cesar dos Santos; JARDIM, Carlos Vianna Poyares; ALVES JR., Jose Leonidas; OLEAS, Francisca Alexandra Gavilanes; MORINAGA, Luciana Tamie Kato; SOUZA, Rogerio de
    Acute pulmonary thromboembolism (APTE) is a highly prevalent condition (104-183 cases per 100,000 person-years) and is potentially fatal. Approximately 20% of patients with APTE are hypotensive, being considered at high risk of death. In such patients, immediate lung reperfusion is necessary in order to reduce right ventricular afterload and to restore hemodynamic stability. To reduce pulmonary vascular resistance in APTE and, consequently, to improve right ventricular function, lung reperfusion strategies have been developed over time and widely studied in recent years. In this review, we focus on advances in the indication and use of systemic thrombolytic agents, as well as lung reperfusion via endovascular and classical surgical approaches, in APTE.
  • conferenceObject
    Prognostic value of predicted 6MWD in PAH
    (2015) GAVILANES, Francisca; ALVES- JR., Jose Leonidas; PRADA, Luis Felipe; FERNANDES, Caio; VITORIO, Patricia; MORINAGA, Luciana; HOETTE, Susana; JARDIM, Carlos; SOUZA, Rogerio
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    Idiopathic Pulmonary Arterial Hypertension Leading To Dynamic Bronchial Compression And Orthopnea: A Case Report Of The Use Of Electrical Impedance Tomography (eit) As A New Investigation Tool In Pulmonary Function Test
    (2015) ARIMURA, F. E.; SANTIAGO, R. R. S. S.; GAVILANES, F.; ALVES, J. L.; JARDIM, C.; AMATO, M. B. P.; COSTA, E. L. V.; SALGE, J. M.; SOUZA, R.
  • article 21 Citação(ões) na Scopus
    New anticoagulants for the treatment of venous thromboembolism
    (2016) FERNANDES, Caio Julio Cesar dos Santos; ALVES JUNIOR, Jose Leonidas; GAVILANES, Francisca; PRADA, Luis Felipe; MORINAGA, Luciana Kato; SOUZA, Rogerio
    Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context.