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  • article 1 Citação(ões) na Scopus
    Influence of patent ductus arteriosus on left ventricular myocardial deformation in preterm neonates in the early neonatal period
    (2020) ALMEIDA, Kellen Freitas Silva de; LEAL, Gabriela Nunes; MORHY, Samira Saady; RODRIGUES, Ana Clara Tude; CERRI, Giovanni G.; DORIA-FILHO, Ulysses; ANDRADE, Jose Lazaro de
  • article 43 Citação(ões) na Scopus
    Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians
    (2014) GASPAR, Heloisa A.; MORHY, Samira S.; LIANZA, Alessandro C.; CARVALHO, Werther B. de; ANDRADE, Jose L.; PRADO, Rogerio R. do; SCHVARTSMAN, Claudio; DELGADO, Artur F.
    Background: Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms. Methods: Theoretical and practical training sessions were conducted with 16 pediatric intensivist/ emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/ cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers. The evaluations occurred after 8, 16 and 24 practical examinations. Results: The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p = 0.004). The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m(2), respectively, after the third stage of training. Conclusions: The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians' technical skills and the care of critically ill patients.
  • article 13 Citação(ões) na Scopus
    Long-term evaluation of cardiac function in juvenile idiopathic arthritis under anti-TNF therapy
    (2014) LIANZA, A. C.; AIKAWA, N. E.; MORAES, J. C. B.; LEAL, G. N.; MORHY, S. S.; ANDRADE, J. L.; BONFA, E.; SILVA, C. A.
    Objective This paper aims to perform global assessment of long-term cardiac function in juvenile idiopathic arthritis (JIA) patients under TNF blockage therapy. Methods Twenty-five polyarticular-course JIA patients pre-anti-TNF and 22 healthy controls underwent conventional/tissue Doppler echocardiography and cardiac biomarkers measurements (N-terminal pro-brain natriuretic peptide [NT-pro-BNP] and troponin T) at baseline (BL). Twenty-one JIA patients completed six evaluations during two consecutive years. Clinical/laboratorial evaluations were assessed before and during TNF blockage therapy. Results JIA patients and controls were comparable regarding current age (p=0.898) and female gender (p=0.38). At BL isoyolumetric relaxation time of left ventricle (p=0.03), ventricular septum (VS), E' wave (p=0.014) and VS S wave velocity (p=0.03) were significantly reduced in JIA patients compared to controls. Frequencies of elevated NT-pro-BNP and troponin T levels were similar in JIA and controls (p=0.297 and p=0.756) and levels remained within normal range throughout the study, except for one patient with mild troponin T elevation. During TNF blockage therapy, none of the 21 participants had heart failure, ejection fraction or other parameters alterations in conventional and tissue Doppler. Only one had mild pulmonary hypertension. Further analysis revealed that JIA patients with elevated levels of NT-pro-BNP at BL had significantly more active joints (p=0.025) and higher ESR (p=0.034). Conclusion Long-term TNF blockage safety was demonstrated in JIA patients in spite of the observed subclinical diastolic involvement. Elevated cardiac biomarker in these patients was associated with inflammatory parameters reinforcing the need for a careful interpretation of this finding in patients with active disease.
  • article 10 Citação(ões) na Scopus
    Advantages of early replacement therapy for mucopolysaccharidosis type VI: echocardiographic follow-up of siblings
    (2014) LEAL, Gabriela N.; PAULA, Ana C. de; MORHY, Samira S.; ANDRADE, Jose L.; KIM, Chong A.
    Mucopolysaccharidosis type VI (Marateaux-Lamy syndrome) is an autosomal recessive disorder caused by deficient activity of the enzyme N-acetylgalactosamine-4-sulphatase (arylsulphatase B). Cytoplasmic vacuoles full of dermatan sulphate are observed in endothelial cells, myocyte, and fibroblasts, compromising the function of cardiovascular structures and contributing significantly towards morbidity and mortality. The primary objective of this study was to assess the advantages of early replacement therapy with recombinant human arylsulphatase B through the echocardiographic follow-up of sisters who started treatment at quite different ages: one at 9 years and the other at 1 year and 7 months. The older sibling showed striking mitral and aortic valve compromise when she was only 2 years old and finally needed cardiac surgery at the age of 8, even before starting enzyme replacement. Differently, the younger one has developed only mild mitral and aortic lesions throughout the follow-up period of 3 years. The two siblings had left ventricle cardiomyopathy, but partial reverse remodelling was induced by enzyme replacement therapy in both cases. The younger sibling has never received any cardiovascular drugs, whereas the older one has been using beta-blockers and diuretics in addition to enzyme therapy to cope with heart failure. Comparing the outcomes of these two sisters with a very aggressive phenotype of mucopolysaccharidosis type VI, the conclusion was that early onset of therapy may slow down the disease progression and prevent severe cardiac lesions to be established. Moreover, patients' compliance is essential for the success of treatment, as sequential echocardiographic evaluation demonstrated worsening of some cardiac lesions whenever infusions were missed.
  • conferenceObject
    Long-Term Evaluation Of Cardiac Function In Juvenile Idiopathic Arthritis Under Anti-Tumor Necrosis Factor Therapy
    (2013) LIANZA, Alessandro C.; AIKAWA, Nadia E.; MORAES, Julio C. B.; LEAL, Gabriela N.; MORHY, Samira S.; BONFA, Eloisa; SILVA, Clovis A.
  • article 1 Citação(ões) na Scopus
    Percutaneous Treatment of Secondary Mitral Regurgitation by MitraClip: Mitra-FR vs. COAPT
    (2021) BARROS-GOMES, Sergio; TARASOUTCHI, Flavio; RODRIGUES, Ana Clara Tude; NHOLA, Lara Ferreira; LEMOS, Pedro Alves; MORHY, Samira Saady; FISCHER, Claudio Henrique; VIEIRA, Marcelo Luiz Campos