ALFREDO INACIO FIORELLI
Projetos de Pesquisa
Unidades Organizacionais
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/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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- 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.
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.