RODRIGO RUANO
Projetos de Pesquisa
Unidades Organizacionais
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
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conferenceObject Acute death of the recipient twin after fetoscopic laser surgery for twin-twin transfusion syndrome related to maternal hypotension and type of anesthesia during the procedure(2012) RUANO, Rodrigo; Kim Nguyen; DOTY, Morgen; JOHNSON, Anthony; BELFORT, Michael; MOISE JR., KennethOBJECTIVE: To evaluate the relationship between acute recipient fetal demise following fetoscopic placental laser ablation and maternal hypotension associated with maternal anesthesia in twin-twin transfusion syndrome (TTTS). STUDY DESIGN: Between November 2006 and March 2011, all cases with TTTS that had recipient fetal demise within 24 hours of placental laser ablation were reviewed. For comparison, each case was matched for gestational age at procedure, Quintero staging of the disease and pre-operative Doppler studies with two cases that did not have acute recipient demise. The presence of maternal hypotension (defined as a decline in blood pressure of 20% from pre-operative values) and the duration of the hypotension were evaluated as possible links to acute recipient demise. RESULTS: Acute recipient demise occurred in 5.6% cases (15/267) following laser ablation. Recipient demise was associated with maternal hypotension (OR: 4.9, 95%CI: 1.3-18.7; p 0.02) and the duration of hypotension (OR: 3.33, 95% CI: 1.8-13.6; p 0.02). ROC curve analysis showed the threshold for maternal hypotension and duration of hypotension associated with recipient demise to be 20% and 35 minutes, respectively. General anesthesia was related with maternal hypotension (OR: 19.1, 95% CI: 3.9-94.1; p 0.01). The duration of surgery and anesthesia were not associated with maternal hypotension or acute recipient demise (p 0.23 and p 0.90, respectively). CONCLUSION: Acute recipient demise following fetos copic placental laser ablation for treatment of severe TTTS is associated with maternal hypotension and general anesthesia during the procedure.conferenceObject Three-dimensional power Doppler study of fetal cerebral vascularity in twin-twin transfusion syndrome after fetoscopic laser photocoagulation(2012) RUANO, Rodrigo; JOHNSON, Anthony; BELFORT, Michael; MOISE JR., KennethOBJECTIVE: To evaluate the fetal cerebral vascularity in pregnancies complicated by twin-twin syndrome transfusion syndrome (TTTS) after laser coagulation of the placental anastomoses. STUDY DESIGN: Between July 2010 and May 2011, 36 monochorionic, diamniotic pregnancies with TTTS underwent 3D-power Doppler ultrasonography in order to evaluate the cerebral vascularization index (VI) in both donor and recipient fetuses before and one day after fetoscopic photocoagulation. RESULTS: Mean gestational age at the fetoscopic procedure was 20.5 2.8 weeks. Before the laser procedure, the mean VI in the recipients was higher than in the donors (12.7 6.8% vs 9.5 5.4%, respectively; p < 0.01). After laser procedure, the mean VI in the recipients and donors was similar (12.4 6.6% and 13.9 6.7%, respectively; p = 0.36) (Figure 1). This change represented a significant increase in the donor VIpost-laser(p < 0.01).WhenQuinterostagingwasconsidered,these differences between recipient and donor VI before and after laser procedure were only observed in stages III/IV (p < 0.01 and p < 0.01, respectively), but not in stages I/II (p = 0.28 and p = 0.36, respectively). CONCLUSION: After fetoscopic laser surgery for TTTS, there is an increase in the cerebral blood flow of the donor fetus so that it becomes more similar to its recipient sibling. This occurs predominantly in TTTS Quintero stages III/IV.- Defining ""liver-up"": does the volume of liver herniation predict outcome for fetuses with isolated left-sided congenital diaphragmatic hernia?(2012) LAZAR, David A.; RUANO, Rodrigo; CASS, Darrell L.; MOISE JR., Kenneth J.; JOHNSON, Anthony; LEE, Timothy C.; CASSADY, Christopher I.; OLUTOYE, Oluyinka O.Purpose: The aim of the study was to evaluate the relationship between the degree of liver herniation and mortality or need for extracorporeal membrane oxygenation (ECMO) in isolated left-sided congenital diaphragmatic hernia (CDH). Methods: This is a retrospective review of all fetuses with isolated left-sided Bochdalek-type CDH evaluated at our center with ultrafast fetal magnetic resonance imaging between January 2004 and December 2010. Percentage of liver herniation was defined as the ratio of herniated liver volume to total fetal liver volume. The liver/thoracic volume ratio was defined as the ratio of herniated liver volume to total thoracic volume. Data were analyzed using receiver operating characteristic curves and Fisher's Exact and Mann-Whitney U tests. Results: Fifty-three fetuses with isolated left-sided CDH were evaluated. Fetuses with ""liver-up"" (n = 32) and ""liver-down"" (n = 21) anatomy had similar rates of mortality (25% vs 14%, P =.49) and ECMO use (41% vs 29%, P = .40). The accuracy of liver-up (a dichotomous variable) to predict mortality or need for ECMO was 49% and 53%, respectively. Percentage of liver herniation greater than 21% was associated with mortality (P < .001) or need of ECMO (P < .001), with an accuracy of 87% and 79%, respectively. Liver/thoracic volume ratio of greater than 14% was also associated with mortality or ECMO use (P < .001 and P = .01, respectively), with an accuracy of 85% and 72%, respectively. Conclusion: Increased amounts of liver herniation in fetuses with isolated left-sided CDH are associated with higher rates of mortality or the need for ECMO support. Quantification of liver herniation (a continuous variable) is superior to overall liver herniation as a dichotomous variable (liver-up vs liver-down) in the prediction of perinatal morbidity and mortality.
conferenceObject Prenatal magnetic resonance imaging parameters predict mortality and the need for extracorporeal membrane oxygenation in isolated congenital diaphragmatic hernia(2012) RUANO, Rodrigo; LAZER, David; LEE, Timothy; MOISE JR., Kenneth; JOHNSON, Anthony; CASSADY, Christopher; BELFORT, Michael; CASS, Darrell L.; OLUTOYE, OluyinkaObjective To determine the association between MRI findings and mortality or need for extracorporeal membrane oxygenation (ECMO) in cases of isolated congenital diaphragmatic hernia (CDH). Study Design Retrospective cohort study of all fetuses with isolated CDH followed in between January 2004 and July 2011. The following MRI parameters were evaluated between 20 and 32 weeks: i) the observed/expected total fetal lung volume (o/e-TLV); ii) the predicted pulmonary volume (PPV) calculated by the lung/thoracic volume ratio; iii) the percentage of liver herniated into fetal thorax (%LH), calculated by the herniated liver/total liver volume ratio; iv) the liver/thoracic volume ratio (LiTh). The predictability of MRI parameters for mortality and need for ECMO was evaluated by univariate, multiple regression, factor analysis and ROC curves. Results 71 fetuses with isolated (61 left and 10 right) CDH were evaluated. Overall mortality was 17/71 (23.9%). One fetus died in utero, and one died a few hours after birth. ECMO was indicated in 26/69 (37.7%) newborns with survival rate of 50.0%. The side of the diaphragmatic defect was not associated with mortality (p=0.55) or the need for ECMO (p=0.49). Good correlation was observed between o/e-TLV and PPV (r=0.47; p0.05). All four MRI parameters were statistically associated with mortality or need for ECMO (Table 1). The best combination to predict mortality using MRI − o/e-TLV+%LH with probability of death=exp(−0.35+(0.87x(1−o/eTLV))+(0.01x%LH))/(1+(exp(−0.35+(0.87x(1−o/eTLV))+(0.01x%LH))). ECMO was used in cases with higher probability of death (>60%) when compared to those that did not need ECMO (probability of death less than 40%; p<0.01). Full-size table Table options Conclusion Mortality and need for ECMO in neonates with isolated CDH can be accurately predicted during prenatal life using MRI through the combination of fetal lung volume measurements and the amount of liver herniated into the fetal thorax.conferenceObject Indications for preterm birth in a cohort of patients with severe twin-twin transfusion after fetoscopic laser surgery(2012) PAPANNA, Ramesha; BLOCK-ABRAHAM, Dana; RUANO, Rodrigo; MANN, Lovepreet; PEREZ, Coral; RUPP, Courtney; MOISE, Kenneth; JOHNSON, AnthonyconferenceObject Predictors for acute fetal demise immediately after fetoscopic laser coagulation in twin-twin transfusion syndrome(2012) PAPANNA, Ramesha; RUANO, Rodrigo; JOHNSON, Anthony; MOISE, Karen; BELFORT, Michael; MOISE, Kenneth