CARLOS MANUEL DE ALMEIDA BRANDAO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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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- Infectious agents is a risk factor for myxomatous mitral valve degeneration: A case control study(2017) TIVERON, Marcos Gradim; POMERANTZEFF, Pablo Maria Alberto; HIGUCHI, Maria de Lourdes; REIS, Marcia Martins; PEREIRA, Jaqueline de Jesus; KAWAKAMI, Joyce Tieko; IKEGAMI, Renata Nishiyama; BRANDAO, Carlos Manuel de Almeida; JATENE, Fabio BiscegliBackground: The etiology of myxomatous mitral valve degeneration (MVD) is not fully understood and may depend on time or environmental factors for which the interaction of infectious agents has not been documented. The purpose of the study is to analyze the effect of Mycoplasma pneumoniae (Mp), Chlamydophila pneumoniae (Cp) and Borrelia burgdorferi (Bb) on myxomatous mitral valve degeneration pathogenesis and establish whether increased in inflammation and collagen degradation in myxomatous mitral valve degeneration etiopathogenesis. Methods: An immunohistochemical test was performed to detect the inflammatory cells (CD20, CD45, CD68) and Mp, Bb and MMP9 antigens in two groups. The in situ hybridization was performed to detect Chlamydophila pneumoniae and the bacteria study was performed using transmission electron microscopy. Group 1 (n = 20), surgical specimen composed by myxomatous mitral valve degeneration, and group 2 (n = 20), autopsy specimen composed by normal mitral valve. The data were analyzed using SigmaStat version 20 (SPSS Inc., Chicago, IL, USA). The groups were compared using Student's t test, Mann-Whitney test. A correlation analysis was performed using Spearman's correlation test. P values lower than 0.05 were considered statistically significant. Results: By immunohistochemistry, there was a higher inflammatory cells/mm2 for CD20 and CD45 in group 1, and CD68 in group 2. Higher number of Mp and Cp antigens was observed in group 1 and more Bb antigens was detected in group 2. The group 1 exhibited a positive correlation between the Bb and MVD percentage, between CD45 and Mp, and between MMP9 with Mp. These correlations were not observed in the group 2. Electron microscopy revealed the presence of structures compatible with microorganisms that feature Borrelia and Mycoplasma characteristics. Conclusions: The presence of infectious agents, inflammatory cells and collagenases in mitral valves appear to contribute to the pathogenesis of MVD. Mycoplasma pneumoniae was strongly related with myxomatous mitral valve degeneration. Despite of low percentage of Borrelia burgdorferi in MD group, this agent was correlated with myxomatous degeneration and this may occour due synergistic actions between these infectious agents likely contribute to collagen degradation.
- Impact of the First Wave of the COVID-19 Pandemic on Cardiovascular Surgery in Brazil: Analysis of a Tertiary Reference Center(2022) LISBOA, Luiz Augusto; MEJIA, Omar Asdrubal Vilca; ARITA, Elisandra Trevisan; GUERREIRO, Gustavo Pampolha; SILVEIRA, Lucas Molinari Veloso Da; BRANDAO, Carlos Manuel De Almeida; DIAS, Ricardo Ribeiro; DALLAN, Luis Roberto Palma; MIANA, Leonardo; CANEO, Luiz F.; JATENE, Marcelo Biscegli; DALLAN, Luis Alberto Oliveira; JATENE, Fabio Biscegli
- 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
- Late outcome analysis of the Braile Biomedica (R) pericardial valve in the aortic position(2014) AZEREDO, Lisandro Goncalves; VERONESE, Elinthon Tavares; SANTIAGO, Jose Augusto Duncan; BRANDAO, Carlos Manuel de Almeida; POMERANTZEFF, Pablo Maria Alberto; JATENE, Fabio BiscegliObjective: Aortic valve replacement with Braile bovine pericardial prosthesis has been routinely done at the Heart Institute of the Universidade de Sao Paulo Medical School since 2006. The objective of this study is to analyze the results of Braile Biomedica (R) aortic bioprosthesis in patients with aortic valve disease. Methods: We retrospectively evaluated 196 patients with aortic valve disease submitted to aortic valve replacement with Braile Biomedica (R) bovine pericardial prosthesis, between 2006 and 2010. Mean age was 59.41 +/- 16.34 years and 67.3% were male. Before surgery, 73.4% of patients were in NYHA functional class III or IV. Results: Hospital mortality was 8.16% (16 patients). Linearized rates of mortality, endocarditis, reintervention, and structural dysfunction were 1.065%, 0.91%, 0.68% and 0.075% patients/year, respectively. Actuarial survival was 90.59 +/- 2.56% in 88 months. Freedom from reintervention, endocarditis and structural dysfunction was respectively 91.38 +/- 2.79%, 89.84 +/- 2.92% and 98.57 +/- 0.72% in 88 months. Conclusion: The Braile Biomedica (R) pericardial aortic valve prosthesis demonstrated actuarial survival and durability similar to that described in the literature, but further follow up is required to assess the incidence of prosthetic valve endocarditis and structural dysfunction in the future.
- Analysis of > 100,000 Cardiovascular Surgeries Performed at the Heart Institute and a New Era of Outcomes(2020) V, Omar A. Mejia; LISBOA, Luiz Augusto Ferreira; CANEO, Luiz Fernando; ARITA, Elisandra Trevisan; BRANDAO, Carlos Manuel de Almeida; DIAS, Ricardo Ribeiro; COSTA, Roberto; JATENE, Marcelo Biscegli; POMERANTZEFF, Pablo Maria Alberto; DALLAN, Luis Alberto Oliveira; JATENE, Fabio BiscegliBackground: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clinicas Heart Institute of the University of Sao Paulo Medical School (InCor-HCFMUSP). Methods: An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion: In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.
- The Double-Orifice Technique in Mitral Valve Repair: 35 Years of History(2021) POMERANTZEFF, Pablo Maria Alberto; BRANDAO, Carlos Manuel de Almeida; RISO, Arlindo; JATENE, Fabio Biscegli
- Carcinoid Heart Disease: A Case Report and Literature Review(2023) COSTA, Isabela Bispo Santos da Silva; MELO, Edielle de Sant Anna; FURTADO, Armando; SOBRAL-ALVES, Juliana Barbosa; RIZK, Stephanie Itala; BENVENUTI, Luiz Alberto; ROCHITTE, Carlos E.; BRANDAO, Carlos Manuel de Almeida; POMARENTZEFF, Pablo Maria; BITTAR, Cristina Salvadori; GALAS, Filomena Regina Barbosa Gomes; AULER JUNIOR, Jose Otavio Costa; HOFF, Paulo Marcelo Gehm; KALIL FILHO, Roberto; JATENE, Fabio Biscegli; HAJJAR, Ludhmila Abrahao
- Mitral annulus morphologic and functional analysis using real time tridimensional echocardiography in patients submitted to unsupported mitral valve repair(2015) GUEDES, Marco Antonio Vieira; POMERANTZEFF, Pablo Maria Alberto; BRANDAO, Carlos Manuel de Almeida; VIEIRA, Marcelo Luiz Campos; TARASOUTCHI, Flavio; SPINOLA, Pablo da Cunha; JATENE, Fabio BiscegliIntroduction: Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce. Objective: To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique. Methods: Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05. Results: There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study. Conclusion: Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.
- Redo aortic valve surgery in a case of dextrocardia with situs inversus totalis(2022) DINATO, Fabricio Jose; BRANDAO, Carlos Manuel de Almeida; VERONESE, Elinthon Tavares; POMERANTZEFF, Pablo Maria Alberto; JATENE, Fabio BiscegliIntroduction: Dextrocardia is a rare congenital cardiac anomaly where the base-apex axis of the heart is directed to the right side. It may be associated with situs solitus, situs inversus, or situs ambiguous. Such cases are technically challenging when heart surgery is needed. Presentation of case: We presented a case of a patient with dextrocardia and situs inversus totalis, who had severe aortic bioprosthetic valve degeneration needing a redo aortic valve replacement. Our operative strategy was to change the position of the main surgeon to the left side of the patient to perform most surgical steps. Discussion: A meticulous pre-operative surgical plan involving the whole team was very important for a smooth intra-operative course and a favourable outcome. Regarding the position of the main surgeon standing on the left side of the patient, we believed this surgical team arrangement added much to the technical ease for the pro-cedure, since the anatomy was opposite to what our minds are used to. Also, computed tomography scan played a crucial role for a proper preoperative anatomical evaluation and surgical planning. Conclusion: Our approach with the surgeon on the left side provided excellent exposure for redo aortic valve replacement in dextrocardia with situs inversus totalis. This surgical management played an important role for the good result in this technically challenging scenario.
- Partial pericardiectomy for refractory acute tuberculous pericarditis: A case report(2023) FERNANDES, Andre Loureiro; DINATO, Fabricio Jose; VERONESE, Elinthon Tavares; BRANDAO, Carlos Manuel de Almeida; AIELLO, Vera Demarchi; JATENE, Fabio BiscegliIntroduction: Tuberculosis is an infectious disease that usually manifests in the lungs but can also affect other organs, including the cardiovascular system. In this article, we present a rare case of purulent pericarditis caused by Mycobacterium tuberculosis. Presentation of case: A 67-year-old man was admitted to the emergency department with a large pericardial effusion with evidence of cardiac tamponade caused by acute pericarditis. The patient underwent surgical pericardial drainage, and a total volume of 500 mL of purulent fluid was collected with a positive culture for Mycobacterium tuberculosis. Despite antituberculous drugs, the patient presented with clinical worsening and recurrence of large pericardial effusion. Therefore, he was submitted to a second intervention by full median sternotomy to drain the pericardial effusion and perform a surgical pericardial debridement associated with a partial pericardiectomy. After the procedure, he improved clinically and was discharged after 24 days of hospitalization. Discussion: Pericardiectomy is recommended for patients with refractory tuberculous pericarditis after four to eight weeks of antituberculous treatment. We decided not to wait that long to perform an open surgical partial pericardiectomy and debridement with a median sternotomy approach. We believe that this more aggressive surgical approach would be more efficient to combat the infection, which was causing progressive deterioration of patient's clinical condition and early recurrence of significant pericardial effusion.Conclusion: Open partial pericardiectomy with surgical debridement could be an efficient approach for treatment of a refractory acute tuberculous pericarditis.