FLAVIO TARASOUTCHI

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/64, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 3 Citação(ões) na Scopus
    Longitudinal Shortening of the Left Ventricle by Cine-CMR for Assessment of Diastolic Function in Patients with Aortic Valve Disease
    (2020) RIBEIRO, Sergio Marrone; AZEVEDO FILHO, Clerio Francisco de; SAMPAIO, Roney; TARASOUTCHI, Flavio; GRINBERG, Max; KALIL-FILHO, Roberto; ROCHITTE, Carlos Eduardo
    Background: Diastolic dysfunction, commonly evaluated by echocardiography, is an important early finding in many cardiomyopathies. Cardiac magnetic resonance (CMR) often requires specialized sequences that extends the test time. Recently, feature-tracking imaging has been made available, but still requires expensive software and lacks clinical validation. Objective: To assess diastolic function in patients with aortic valve disease (AVD) and compare it with normal controls by evaluating left ventricular (LV) longitudinal displacement by CMR. Methods: We compared 26 AVD patients with 19 normal controls. Diastolic function was evaluated as LV longitudinal displacement in 4-chamber view cine-CMR images using steady state free precession (SSFP) sequence during the entire cardiac cycle with temporal resolution < 50 ms. The resulting plot of atrioventricular junction (AVJ) position versus time generated variables of AVJ motion. Significance level of p < 0.05 was used. Results: Maximum longitudinal displacement (0.12 vs. 0.17 cm), maximum velocity during early diastole (MVED, 0.6 vs. 1.4s(-1)), slope of the best-fit line of displacement in diastasis (VDS, 0.22 vs. 0.03s(-1)), and VDS/MVED ratio (0.35 vs. 0.02) were significantly reduced in AVD patients compared with controls, respectively. Aortic regurgitation showed significantly worse longitudinal LV shortening compared with aortic stenosis. Higher LV mass indicated worse diastolic dysfunction. Conclusions: A simple linear measurement detected significant differences on LV diastolic function between AVD patients and controls. LV mass was the only independent predictor of diastolic dysfunction in these patients. This method can help in the evaluation of diastolic dysfunction, improving cardiomyopathy detection by CMR, without prolonging exam time or depending on expensive software.
  • article 0 Citação(ões) na Scopus
    Cardiac Magnetic Resonance Analysis of Mitral Annular Dynamics after Mitral Valve Repair
    (2020) ABDOUNI, Ahmad A.; BRANDAO, Carlos M. A.; ROCHITTE, Carlos E.; POMERANTZEFF, Pablo M. A.; VERONESE, Elinthon T.; PACHECO, Ariane B.; SANTIS, Antonio S.; TARASOUTCHI, Flavio; JATENE, Fabio B.
    OBJECTIVES: The aim of this study was to analyze mitral annulus (MA) dynamics using cardiac magnetic resonance (CMR) in patients with degenerative mitral insufficiency who underwent mitral valve repair (MVR). METHODS: Mitral valve imaging was performed by CMR in twenty-nine patients with degenerative mitral insufficiency who underwent MVR between July 2014 and August 2016, with quadrangular resection of the posterior leaflet without ring annuloplasty. They were prospectively followed up from the preoperative period up to 2 years postoperatively. RESULTS: We observed a significant reduction in all measurements of the MA after surgery. The mean systolic circumference of the MA was reduced from 13.28 +/- 1.95 cm to 11.50 +/- 1.59 cm, and the diastolic circumference was reduced from 12.51 +/- 2.01 cm to 10.66 +/- 2.09 cm in the immediate postoperative period, measures that remained stable 2 years after MVR (p < 0.001). The mean maximum area of the MA was significantly reduced from 14.34 +/- 4.03 to 10.45 +/- 3.17 cm(2) when comparing the immediate postoperative period and the 2 year follow-up (p <0.001). The same occurred with the mean minimum area of the MA, which was reduced from 12.53 +/- 3.68 cm(2) to 9.23 +/- 2.84 cm(2) in the same period, and this reduction was greater in the antero-posterior diameter than in the mid-lateral diameter. The mobility of the MA was preserved after surgery, ranging between 19.6% and 25.7% at 2-year follow-up. CONCLUSION: We observed a significant reduction in the MA size after MVR, with preservation of the MA mobility at the 2-year follow-up.
  • article
    Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020 (vol 14, pg 849, 2020)
    (2020) AVILA, Walkiria Samuel; ALEXANDRE, Elizabeth Regina Giunco; CASTRO, Marildes Luiza de; LUCENA, Alexandre Jorge Gomes de; MARQUES-SANTOS, Celi; FREIRE, Claudia Maria Vilas; ROSSI, Eduardo Giusti; CAMPANHARO, Felipe Favorette; RIVERA, Ivan Romero; COSTA, Maria Elizabeth Navegantes Caetano; RIVERA, Maria Alayde Mendonca; CARVALHO, Regina Coeli Marques de; ABZAID, Alexandre; MORON, Antonio Fernandes; RAMOS, Auristela Isabel de Oliveira; ALBUQUERQUE, Carlos Japhet da Mata; FEIO, Claudine Maia Alves; BORN, Daniel; SILVA, Fabio Bruno da; NANI, Fernando Souza; TARASOUTCHI, Flavio; COSTA JUNIOR, Jose de Ribamar; MELO FILHO, Jose Xavier de; KATZ, Leila; ALMEIDA, Maria Cristina Costa; GRINBERG, Max; AMORIM, Melania Maria Ramos de; MELO, Nilson Roberto de; MEDEIROS, Orlando Otavio de; POMERANTZEFF, Pablo Maria Alberto; BRAGA, Sergio Luiz Navarro; CRISTINO, Sonia Conde; MARTINEZ, Tania Leme da Rocha; LEAL, Tatiana de Carvalho Andreuci Torres
  • article 28 Citação(ões) na Scopus
    Update of the Brazilian Guidelines for Valvular Heart Disease-2020
    (2020) TARASOUTCHI, Flavio; MONTERA, Marcelo Westerlund; RAMOS, Auristela Isabel de Oliveira; SAMPAIO, Roney Orismar; ROSA, Vitor Emer Egypto; ACCORSI, Tarso Augusto Duenhas; SANTIS, Antonio de; FERNANDES, Joao Ricardo Cordeiro; PIRES, Lucas Jose Tachotti; SPINA, Guilherme S.; VIEIRA, Marcelo Luiz Campos; LAVITOLA, Paulo de Lara; AVILA, Walkiria Samuel; PAIXAO, Milena Ribeiro; BIGNOTO, Tiago; TOGNA, Dorival Julio Della; MESQUITA, Evandro Tinoco; ESTEVES, William Antonio de Magalhaes; ATIK, Fernando; COLAFRANCESCHI, Alexandre Siciliano; MOISES, Valdir Ambrosio; KIYOSE, Alberto Takeshi; POMERANTZEFF, Pablo M. A.; LEMOS, Pedro A.; BRITO JUNIOR, Fabio Sandoli de; WEKSLER, Clara; BRANDAO, Carlos Manuel de Almeida; POFFO, Robinson; SIMOES, Ricardo; RASSI, Salvador; LEAES, Paulo Ernesto; MOURILHE-ROCHA, Ricardo; PENA, Jose Luiz Barros; JATENE, Fabio Biscegli; BARBOSA, Marcia de Melo; ABIZAID, Alexandre; RIBEIRO, Henrique Barbosa; BACAL, Fernando; ROCHITTE, Carlos Eduardo; FONSECA, Jose Honorio de Almeida Palma; GHORAYEB, Samira Kaissar Nasr; LOPES, Marcelo Antonio Cartaxo Queiroga; SPINA, Salvador Vicente; PIGNATELLI, Ricardo H.; SARAIVA, Jose Francisco Kerr
  • article 14 Citação(ões) na Scopus
    Biomarkers for prediction of mortality in left-sided infective endocarditis
    (2020) SICILIANO, Rinaldo F.; GUALANDRO, Danielle M.; BITTENCOURT, Marcio Sommer; PAIXAO, Milena; MARCONDES-BRAGA, Fabiana; SOEIRO, Alexandre de Matos; STRUNZ, Celia; PACANARO, Ana Paula; PUELACHER, Christian; TARASOUTCHI, Flavio; SOMMA, Salvatore Di; CARAMELLI, Bruno; OLIVEIRA JUNIOR, Mucio Tavares de; MANSUR, Alfredo Jose; MUELLER, Christian; BARRETTO, Antonio Carlos Pereira; STRABELLI, Tania Mara Varejao
    Background: Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE. Methods: Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis fator a (TNF-a), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality. Results: Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8-6.4; P < 0.001), BNP (OR 2.7; 95%CI 1.4-5.1; P = 0.002), IL-6 (OR 2.06; 95%CI 1.3-3.7; P = 0.019), procalcitonin (OR 1.9; 95%CI 1.1-3.2; P = 0.018), TNF-alpha (OR 1.8; 95%CI 1.1-2.9; P = 0.019), and CRP (OR 1.8; 95%CI 1.0-3.3; P = 0.037). At admission, S-cTnI provided the highest accuracy for predicting mortality (area under the ROC curve: s-cTnI 0.812, BNP 0.727, IL-6 0.734, procalcitonin 0.684, TNF-alpha 0.675, CRP 0.670). After 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance (s-cTnI 0.814, BNP 0.823, IL-6 0.695, procalcitonin 0.802, TNF-alpha 0.554, CRP 0.759). Conclusion: S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE. (C) 2020 The Authors.
  • article 6 Citação(ões) na Scopus
    Non-toxigenic Corynebacterium diphtheriae infective endocarditis with embolic events: a case report
    (2020) SANTIS, Antonio de; SICILIANO, Rinaldo Focaccia; SAMPAIO, Roney Orismar; AKAMINE, Masahiko; VERONESE, Elinthon T.; MAGALHAES, Francisco Monteiro de Almeida; ARAUJO, Maria Rita Elmor; ROSSI, Flavia; MAGRI, Marcelo M. C.; NASTRI, Ana Catharina; ACCORSI, Tarso A. D.; ROSA, Vitor E. E.; TITINGER, David Provenzale; SPINA, Guilherme S.; TARASOUTCHI, Flavio
    Background Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. Case presentation A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. Conclusion Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional ""endocarditis team"" is essential to achieve favorable clinical outcomes in such defiant scenarios.
  • article 0 Citação(ões) na Scopus
  • article 66 Citação(ões) na Scopus
    The Role of F-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Left-sided Endocarditis: Native vs Prosthetic Valves Endocarditis
    (2020) CAMARGO, Raphael Abegao de; BITENCOURT, Marcio Sommer; MENEGHETTI, Jose Claudio; JR, Jose Soares; GONCALVES, Luis Fernando Tonello; BUCHPIGUEL, Carlos Alberto; PAIXAO, Milena Ribeiro; FELICIO, Marilia Francesconi; SOEIRO, Alexandre de Matos; STRABELLI, Tania Mara Varejao; MANSUR, Alfredo Jose; TARASOUTCHI, Flavio; JR, Mucio Tavares de Oliveira; CASTELLI, Jussara Bianchi; GUALANDRO, Danielle Menosi; POCEBON, Lucas Zoboli; BLANKSTEIN, Ron; ALAVI, Abass; MOORE, John Edmund; MILLAR, Beverley Cherie; SICILIANO, Rinaldo Focaccia
    Background: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding use of F-18-FDG-PET/CT for the diagnosis of native valve endocarditis (NVE). Methods: Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. F-18-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE)/ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and F-18-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis. Results: Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of F-18-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were 22%, 100%, 100%, and 66%. The inclusion of abnormal F-18-FDG cardiac uptake as a major criterion at admission enabled a recategorization of 76% (47/62) of PVE/AAPI cases initially classified as ""possible"" to ""definite"" IE. In the histopathological analysis, a predominance of polymorphonuclear cell inflammatory infiltrate and a reduced extent of fibrosis were observed in the PVE group only. Conclusions: Use of F-18-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the modified Duke criteria. In patients who present with suspected NVE, the use of F-18-FDG-PET/CT is less accurate and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.
  • article 1 Citação(ões) na Scopus
    Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience
    (2020) NICZ, Pedro Felipe Gomes; MELO, Pedro Henrique M. Craveiro de; BRITO, Pedro Henrique Ferro de; LIMA, Eliane Nogueira; SILVA, Ricardo Cavalcante e; PRUDENTE, Mauricio Lopes; FERNANDES, Fernando Henrique; DEININGER, Maurilio Onofre; LOPES, Marcelo Antonio Cartaxo Queiroga; PETRUCCI, Fulvio Soares; REIS FILHO, Fernando Roquette; MARINO, Marcos Antonio; BERNARDES, Rodrigo de Castro; MELO, Eduardo Pessoa de; OLIVEIRA, Marco Antonio Praca; MANGIONE, Jose Armando; MANGIONE, Fernanda Marinho; FALCAO, Carlos Henrique Eiras; MARTINS, Estevao Carvalho de Campos; LUNARDI, Walter; BACAL, Fernando; TARASOUTCHI, Flavio; BRITO JR., Fabio Sandoli de
    Background: Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment. Objectives: To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV). Methods: Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05. Results: From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC >= III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12 +/- 3.8 mmHg; post-intervention, 5.3 +/- 2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06 +/- 0.59 cm(2); post-intervention, 2.18 +/- 0.36 cm(2); p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9 +/- 16.4 mmHg; post-intervention, 57.7 +/- 16.5 mmHg; 30 days, 50.9 +/- 18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC <= II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up. Conclusion: The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients' selection and of procedural planning.
  • article 2 Citação(ões) na Scopus
    Double transcatheter balloon-expandable valve implantation for severe valve dysfunction in high-risk patients: initial experience
    (2020) BASTOS FILHO, Joao Bosco Breckenfeld; SAMPAIO, Roney Orismar; CIVIDANES, Felipe Reale; ROSA, Vitor Emer Egypto; COSTA, Leonardo Paim Nicolau da; VIEIRA, Marcelo Luiz Campos; JATENE, Fabio Biscegli; TARASOUTCHI, Flavio; PALMA, Jose Honorio; RIBEIRO, Henrique Barbosa
    OBJECTIVES: Concomitant valvular heart valve disease is a frequent finding, with higher morbidity and mortality among patients undergoing redo surgical procedures. Our goal was to report our initial experience with combined transcatheter Inovare bioprosthesis implants for severe valve dysfunction. METHODS: Among 300 transcatheter procedures, a total of 6 patients had concurrent simultaneous transcatheter bioprosthesis implants for severe mitral bioprosthesis failure (valve-in-valve), with a second valve procedure that included native aortic (n = 2) or degenerated bioprostheses in the aortic position (n = 4). During the procedures, all patients were treated with a balloon-expandable Inovare transcatheter valve, using the transapical approach. RESULTS: Patients were highly symptomatic [New York Heart Association (NYHA) functional class IV: 100%], with a mean age of 62 +/- 5 years, yielding a mean European System for Cardiac Operative Risk II (EuroSCORE II) of 24.0 +/- 10.1%. There was a mean of 1.6 +/- 0.4 prior valve operations/patient, with a median time from prior mitral bioprosthesis surgery of 13.0 (9.2-20.0) years. Device success was 100% according to the Mitral Valve Academic Research Consortium and the Valve Academic Research Consortium-2 criteria. During the hospital stay, only 1 patient required dialysis, and the median intensive care unit and hospital lengths of stay were 5.0 (3.2-6.7) days and 16.0 (12.2-21.2) days, respectively. No deaths occurred at 30 days; at a median follow-up of 287 (194-437) days, 1 patient died of a noncardiac cause and the rest of patients were in NYHA functional class I or II, with normofunctioning bioprostheses. CONCLUSIONS: Transcatheter double valve interventions using the Inovare bioprosthesis in this initial series were shown to be a reasonable alternative to redo surgical operations. The short- and mid-term clinical and echocardiographic outcomes demonstrate promising results, although future studies with a larger number of patients and longer follow-up are warranted.