VERA DEMARCHI AIELLO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
13 resultados
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Agora exibindo 1 - 10 de 13
- Atrioventricular Block Pathology in Cardiomyopathy by Desmin Deposition(2012) BENVENUTI, Luiz Alberto; AIELLO, Vera Dermarchi; FALCAO, Breno Alencar Araripe; LAGE, Silvia GelasGenerally, restrictive cardiomyopathy due to desmin deposition is characterized by restriction to ventricular diastolic filling and different degrees of atrioventricular block (AVB). In this report, we describe the pathological changes of the cardiac conduction system related to AVB. The sinus node, the compact node, and the penetrating bundle (bundle of His) had no abnormalities, however, there was extensive fibrosis of the terminal portions of the branching bundle and the beginning of the left and right bundles at the top of the ventricular septum. The pathogenesis of this fibrous replacement is probably the same that leads to extensive fibrosis of the working ventricular myocardium, and remains to be elucidated.
- Comparative Analysis of the Complications of 5347 Endomyocardial Biopsies Applied to Patients After Heart Transplantation and With Cardiomyopathies: A Single-center Study(2012) FIORELLI, A. I.; BENVENUTI, L.; AIELO, V.; COELHO, A. Q.; PALAZZO, J. F.; ROSSENER, R.; BARRETO, A. C. P.; MADY, C.; BACAL, F.; BOCCHI, E.; STOLF, N. A. G.Introduction. Endomyocardial biopsy (EMB) plays an important role in allograft surveillance to screen an acute rejection episode after heart transplantation (HT), to diagnose an unknown cause of cardiomyopathies (CMP) or to reveal a cardiac tumor. However, the procedure is not risk free. Objective. The main objective of this research was to describe our experience with EMB during the last 33 years comparing surgical risk between FIT versus no-HT patients. Method. We analyzed retrospectively the data of 5347 EMBs performed from 1978 to 2011 (33 years). For surveillance of acute rejection episodes after HT we performed 3564 (66.7%), whereas 1777 (33.2%) for CMP diagnosis, and 6 (1.0%) for cardiac tumor identification. Results. The main complications due to EMB were divided into 2 groups to facilitate analysis: major complications associated with potential death risk, and minor complications. The variables that showed a significant difference in the HT group were as follows: tricuspid Injury (.0490) and coronary fistula (.0000). Among the no-HT cohort they were insufficient fragment (.0000), major complications (.0000) and total complications (.0000). Conclusions. EMB can be accomplished with a low risk of complications and high effectiveness to diagnose CMP and rejection after HT. However, the risk is great among patients with CMP due to their anatomic characteristics. Children also constitute a risk group for EMB due to their small size in addition to the heart disease. The risk of injury to the tricuspid valve was higher among the HT group.
conferenceObject Hypercholesterolemic diet worst left ventricular function evaluated by echocardiography in rats subjected to an experimental infarct model(2012) DOURADO, Paulo M.; TSUTSUI, Jeane M.; CASELLA FILHO, Antonio; LANDIM, Mauricio B.; GALVAO, Tatiana F.; AIELLO, Vera D.; LUZ, Protasio Da; MATHIAS JR., Wilson; CHAGAS, Antonio C.Introduction: A better comprehension of the hypercholesterolemic diet role in the set of acute myocardial infarct is fundamental. Objectives: Evaluation of the role of hypercholesterolemic diet in the determination of the hemodynamics patterns by echocardiography. Methods: Sixty three anesthetized rats were subjected to occlusion of the left anterior descending (LAD) coronary artery and divided in six groups: G1–just normal diet (ND); G2–ND and treatment with rosuvastatim for 30 days began after infarct and G3–ND and 30 days previously to infarct treated with rosuvastatim until 30 days after it; G4 –just hypercholesterolemic diet (HD); G5–HD and treatment with rosuvastatim for 30 days began after infarct and G6 –HD and 30 days previously to infarct treated with rosuvastatim until 30 days after it. Echocardiography was performed using bidimensional image in the paraesternal long axis. The planimetry of the left ventricle areas in the end of the diastole (LVEDA) and systole (LVESA) were realized before the infarct (pre) and 30 days after the infarct (post) . A p value<0.05 was considered significant. Conclusion: The hypercholesterolemic diet worst the hemodynamics parameters–LVEDA and LVESA - in comparison with the normocholesterolemic group treated with rosuvastatim.- Case 04/12-A 44-Year-Old Male with Rheumatic Valvular Heart Disease with Multiple Previous Surgeries of Aortic Valve Replacement Admitted for Treatment of Congestive Heart Failure(2012) FERNANDES, Danilo Guercio; MARTINELLI, Luiz Mario Baptista; AIELLO, Vera Demarchi
conferenceObject Histomorphometric evaluation of the arterial valve in Persistent Common Arterial trunk its and possible relation to coronary and aortic arch abnormalities(2012) AIELLO, V. D.; LIGUORI, G. R.; JATENE, M. B.Introduction: Hearts with common arterial trunk (CAT) may show dysplastic arterial valve, which appear to impact on early deaths and on the postoperative prognosis. The morphology of dysplastic leaflets is still poorly defined and usually described qualitatively in the literature as nonspecific fibrous thickening of their margins. Abnormalities of the coronary arteries and of the aortic arch arteries have also been described in CAT, but to date no study has sought to establish objective relations between the truncal valve abnormalities and other morphological features. OBJECTIVE: Systematically assess, both qualitatively and quantitatively, alterations of the truncal valve and check for possible associations with coronary and aortic arch anomalies. Methods: Thirteen heart specimens with CAT were analyzed. Gross features of the coronary ostia (number, position and shape) and aortic arch were annotated. The thickest semilunar leaflet was sampled for histological analysis. Linear measurements were obtained: proximal, medial and distal thicknesses, length and total area of the leaflet. Results: The thickest valvar segments were the medial and distal ones. There was a negative correlation between the distal thickness of the leaflet and the linear distance from the coronary ostium to the valvar commissure (R2 = 0.448; P = 0.024 and R2 = 0.697; P = 0.001, respectively for the left and right coronary ostia). The groups with patent arterial duct and abnormal subclavian artery presented greater medial (P = 0.048; P = 0.044) and distal (P = 0.013; P = 0.028) thickness of the semilunar leaflet. Conclusion: Anomalies of the position (juxtacommissural origin) of the coronary ostia and aortic arch abnormalities are related to the dysplasia of the truncal valve.- Case 1-Hypertensive 58-Year-Old Woman with Hepatic Nodules Presented Dyspnea and Pleural Effusion One Week after an Episode of Pulmonary Embolism(2012) OGAWA, Tania Marie; CABRAL, Ricardo Mauro Ghetti; AIELLO, Vera Demarchi
- Assessment of Stent Strut Endothelialization in Iliac Arteries of Rabbits(2012) TAKIMURA, Celso Kiyochi; WATANABE, Ii-sei; LAURINDO, Francisco Rafael Martins; GUTIERREZ, Paulo Sampaio; AIELLO, Vera Demarchi; MORATO, Spero Penha; LEMOS NETO, Pedro AlvesBackground: Fast post-implantation stent endothelialization is desirable for theoretically reducing the possibility of stent thrombosis. Objective: To evaluate the extent of sirolimus-eluting stent strut endothelialization (delivered from the luminal and abluminal aspects or abluminal aspect only) in the iliac arteries of rabbits. Methods: The iliac arteries of 10 rabbits were implanted with four sirolimus-eluting stents in the luminal and abluminal aspects, three sirolimus-eluting stents in the abluminal aspect, six polymer-coated stents, and four uncoated stents. After four weeks, the rabbits were euthanized and scanning electron microscopy was performed to quantify the area of exposed stent strut as well as the percentage of endothelialization. Results: The area (mean +/- SD) (mm(2)) of exposed uncoated stent struts, polymer-coated stents, sirulimus-eluting stent in the abluminal and luminal aspects and sirolimus-eluting stent in the abluminal aspect was 0.12 +/- 0.08, 0.09 +/- 0.12, 0.60 +/- 0.67 and 0.05 +/- 0.04, respectively (p = 0.120). The percentage of endothelialization (mean +/- SD) (%) of uncoated stents, polymer-coated stents, sirolimus-eluting stents in the luminal and abluminal aspects and sirolimus-eluting stents in the abluminal aspect was 99 +/- 01, 99 +/- 0. 97 +/- 03 and 99 +/- 0, respectively (p = 0.133). Conclusion: After four weeks of implantation in the iliac arteries of rabbits, both the sirolimus-eluting stents in the luminal plus abluminal aspects and those in the abluminal aspect only showed stent strut endothelialization rates similar to those of the other types of non-drug eluting stents.
- Tricuspid Valve Injury After Heart Transplantation Due to Endomyocardial Biopsy: An Analysis of 3550 Biopsies(2012) FIORELLI, A. I.; COELHO, G. H. B.; AIELLO, V. D.; BENVENUTI, L. A.; PALAZZO, J. F.; SANTOS JUNIOR, V. P.; CANIZARES, B.; DIAS, R. R.; STOLF, N. A. G.Introduction. Tricuspid regurgitation (TR) is the most commonly valvular dysfunction found after heart transplantation (HTx). It may be related to endomyocardial biopsy (EMB) performed for allograft rejection surveillance. Objective. This investigation evaluated the presence of tricuspid valve tissue fragments obtained during routine EMB performed after HTx and its possible effect on short-term and long-term hemodynamic status. Method. This single-center review included prospectively collected and retrospectively analyzed data. From 1985 to 2010, 417 patients underwent 3550 EMB after HTx. All myocardial specimens were reviewed to identify the presence of tricuspid valve tissue by 2 observers initially and in doubtful cases by a third observer. The echocardiographic and hemodynamic parameters were only considered for valvular functional damage analysis in cases of tricuspid tissue inadvertently removed during EMB. Results. The 417 HTx patients to 3550 EMB, including 17,550 myocardial specimens. Tricuspid valve tissue was observed in 12 (2.9%) patients corresponding to 0.07% of the removed fragments. The echocardiographic and hemodynamic parameters of these patients before versus after the biopsy showed increased TR in 2 cases (2/12; 16.7%) quantified as moderate without progression in the long term. Only the right atrial pressure showed a significant increase (P = .0420) after tricuspid injury; however, the worsening of the functional class was not significant enough in any of the subjects. Thus, surgical intervention was not required. Conclusions. Histological evidence of chordal tissue in EMB specimens is a real-world problem of relatively low frequency. Traumatic tricuspid valve injury due to EMB rarely leads to severe valvular regurgitation; only a minority of patients develop significant clinical symptoms. Hemodynamic and echocardiographic alterations are also less often observed in most patients.
- Evolução temporal da proliferação neointimal após implante de dois tipos de stent farmacológico com polímeros biodegradáveis em modelo porcino: avaliação qualitativa por tomografia de coerência óptica sequencial(2012) GALON, Micheli Zanotti; TAKIMURA, Celso Kiyochi; CARVALHO, Juliana; CHAVES, Márcio José Figueira; LACCHINI, Silvia; AIELLO, Vera Demarchi; GUTIERREZ, Paulo Sampaio; LAURINDO, Francisco Rafael Martins; LEMOS NETO, Pedro AlvesBACKGROUND: Based on the hypothesis that the neointima found in drug-eluting stents (DES) with biodegradable polymers at 28 days is not a definitive neointima and that optical coherence tomography (OCT) is an effective method for sequential neointimal evaluation, we aim, in this experimental study, to compare OCT findings at 28 and 90 days, in two different DES with biodegradable polymers: the sirolimus-eluting stent (Inspiron®, Scitech) and the biolimus A9-eluting stent (Biomatrix®, Biosensors International). METHODS: Overall, 6 non-atherosclerotic pigs were submitted to the implantation of 6 Inspiron® stents and 6 Biomatrix® stents. Each pig received both stent types, one in each coronary artery (left anterior descending artery and circumflex artery) and after 28 and 90 days qualitative in-stent OCT analyses were performed at 1-millimeter intervals. RESULTS: Qualitative assessment was performed in-stent pairing millimeter by millimeter. Heterogeneous neointimal tissue was evidenced in 39% at 28 days and in 0% at 90 days, the presence of intraluminal tissue in 18% at 28 days and in 0% at 90 days, luminal irregularity in 62% at 28 days and in 2% at 90 days (P < 0.005). There was no difference between groups regarding the quality of the neointima over time (P > 0.05). CONCLUSIONS: The OCT findings corroborate the hypothesis that the neointima found in DES with biodegradable polymers at 28 days is not a definitive neointima. The most significant experimental evidence is the change in the neointimal characteristics observed at sequential OCT.
conferenceObject Trypanosoma cruzi persistence in the native heart is associated with high-grade myocarditis, but not with Chagas' disease reactivation after heart transplantation(2012) BENVENUTI, L. A.; ROGGERIO, A.; CAMPOS, S. V.; FIORELLI, A. I.; AIELLO, V. D.Introduction: Chagas’ disease is caused by the protozoan Trypanosoma cruzi. Around 20% of infected people develop a chronic, inflammatory cardiomyopathy which may progress to end-stage heart failure. Chagas’ disease reactivation (CDR) may occur after heart transplantation (HT), usually in the first year of follow-up. CDR is a life-threatening complication characterized by relapse of the disease with direct detection of T. cruzi parasites in blood or tissues. We investigated if high-grade myocarditis and/or detection of T. cruzi parasites in the native heart are associated with CDR after HT. Material and Methods: The native heart of 16 chagasic patients who presented CDR after HT (CDR+ group) were compared to the native heart of 11 chagasic patients who never presented CDR in a follow-up of at least 18 months after HT (CDR – group). The intensity of myocarditis was evaluated semi-quantitatively. Parasite persistence was investigated through immunohistochemistry for T. cruzi antigens and qualitative polymerase chain reaction (PCR) for T. cruzi kDNA. Fisher exact test was used to compare data. Results: High-grade myocarditis was present in 15/16 (93.8%) samples of CDR+ group and 9/11 (81.8%) samples of CDR – group (P = 0.549). Parasite persistence, mainly detected through the PCR-based assay, occurred in 13/16 (81.3%) samples of CDR+ group and 7/11 (63.6%) samples of CDR – group (P = 0.391). High-grade myocarditis was present in 20/20 (100%) samples presenting parasite persistence and 4/7 (57.1%) samples without parasite persistence (P = 0.012). Conclusion: Although parasite persistence is associated with high-grade myocarditis in the native heart, neither of them is associated with CDR after HT.