VERA DEMARCHI AIELLO

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 22
  • conferenceObject
    Mechanical Esophageal Displacement for Esophageal Safety of Mechanical Esophageal Displacement for Esophageal Thermal Injury Prevention During Atrial Fibrillation Ablation in Swine
    (2019) PEREIRA, Renner; PISANI, Cristiano F.; AIELLO, Vera; CESTARI, Idagene A.; MOURA, Daniel; CHOKR, Muhieddine; HARDY, Carina; SISSY, Melo; SCANAVACCA, Mauricio; HACHUL, Denise
  • article 0 Citação(ões) na Scopus
  • article 8 Citação(ões) na Scopus
    Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments
    (2019) THOMAZ, Ana Maria; KAJITA, Luiz J.; AIELLO, Vera D.; ZORZANELLI, Leina; GALAS, Filomena Regina B. G.; MACHADO, Cleide G.; BARBERO-MARCIAL, Miguel; JATENE, Marcelo B.; RABINOVITCH, Marlene; LOPES, Antonio Augusto
    Management of pediatric pulmonary hypertension associated with congenital heart disease (PHT-CHD) is challenging. Some patients have persistently elevated pulmonary artery pressure (PAP) after cardiac surgery, an undesired condition that is difficult to predict. We investigated the value of clinical, hemodynamic, and histopathological data in predicting the outcome in a prospective cohort. Patients with PHT-CHD received sildenafil orally pre- and postoperatively for six months and then were subjected to a catheter study. Thirty-three patients were enrolled (age range = 4.6-37.0 months). Pulmonary vascular resistance (PVR) was 4.9 (range = 3.9-7.2) Wood units x m(2) (median with IQR). Twenty-two patients had a >= 20% decrease in PVR and pulmonary-to-systemic vascular resistance ratio (PVR/SVR) in response to inhaled nitric oxide (NO). The response was directly related to the degree of medial hypertrophy of pulmonary arterioles (P < 0.05) (morphometric analysis, intraoperative lung biopsy). Subsequently, five of the non-responders had a >= 30% increase in pulmonary blood flow in response to sildenafil (3.0 [2.0-4.0] mg/kg/day). Six months after surgery, PAP and PVR were significantly lower (P < 0.001 vs. baseline), even in seven patients with Heath-Edwards grade III/IV pulmonary vascular lesions (P = 0.018), but still abnormal in 12 individuals (>25 mmHg and >3.0 U x m(2), respectively). A preoperative PVR/SVR of >= 24% during NO inhalation and a wall thickness of arteries accompanying respiratory bronchioli of >= 4.7 (Z score) were identified, respectively, as risk and protection factors for abnormal postoperative hemodynamics (hazard ratio [95% CI] = 1.09 [1.01-1.18], P = 0.036; and 0.69 [0.49-0.98], P = 0.040, respectively). Thus, in PHT-CHD patients receiving oral sildenafil pre- and post-surgical repair of cardiac lesions, mid-term postoperative outcome is predictable to some extent.
  • article 0 Citação(ões) na Scopus
  • article 1 Citação(ões) na Scopus
    Superior caval vein syndrome and cardiac inflammatory myofibroblastic tumour in an infant
    (2023) SOARES, Bernardo Mussi; SOARES, Andressa Mussi; AIELLO, Vera Demarchi
    The inflammatory myofibroblastic tumour, although very rare, must be considered in the differential diagnosis of intracardiac masses in children as it has systemic implications. We present a case of an infant whose diagnosis was suspected on clinical basis and echocardiogram, but the anatomopathological analysis with immunohistochemical study was essential for the conclusion of the histological type and orientation of the clinical follow-up.
  • article 4 Citação(ões) na Scopus
    Ultrahigh resolution spectral-domain optical coherence tomography using the 1000-1600 nm spectral band
    (2022) BERNSTEIN, L. I. A. N. E.; RAMIER, A. N. T. O. I. N. E.; WU, J. I. A. M. I. N.; AIELLO, V. E. R. A. D.; BELAND, M. A. R. I. E. J.; LIN, C. H. A. R. L. E. S. P.; YUN, SEOK-HYUN
    Ultrahigh resolution optical coherence tomography (UHR-OCT) can image micro-scopic features that are not visible with the standard OCT resolution of 5-15 mu m. In previous studies, high-speed UHR-OCT has been accomplished within the visible (VIS) and near-infrared (NIR-I) spectral ranges, specifically within 550-950 nm. Here, we present a spectral domain UHR-OCT system operating in a short-wavelength infrared (SWIR) range from 1000 to 1600 nm using a supercontinuum light source and an InGaAs-based spectrometer. We obtained an axial resolution of 2.6 mu m in air, the highest ever recorded in the SWIR window to our knowledge, with deeper penetration into tissues than VIS or NIR-I light. We demonstrate imaging of conduction fibers of the left bundle branch in freshly excised porcine hearts. These results suggest a potential for deep-penetration, ultrahigh resolution OCT in intraoperative applications. (c) 2022 Optica Publishing Group under the terms of the Optica Open Access Publishing Agreement
  • article 2 Citação(ões) na Scopus
    Expert Consensus Statement: Anatomy, Imaging, and Nomenclature of Congenital Aortic Root Malformations
    (2023) TRETTER, Justin T.; SPICER, Diane E.; FRANKLIN, Rodney C. G.; BELAND, Marie J.; AIELLO, Vera D.; COOK, Andrew C.; CRUCEAN, Adrian; LOOMBA, Rohit S.; YOO, Shi-Joon; QUINTESSENZA, James A.; TCHERVENKOV, Christo I.; JACOBS, Jeffrey P.; NAJM, Hani K.; ANDERSON, Robert H.
    Over the past 2 decades, several categorizations have been proposed for the abnormalities of the aortic root. These schemes have mostly been devoid of input from specialists of congenital cardiac disease. The aim of this review is to provide a classification, from the perspective of these specialists, based on an understanding of normal and abnormal morphogenesis and anatomy, with emphasis placed on the features of clinical and surgical relevance. We contend that the description of the congenitally malformed aortic root is simplified when approached in a fashion that recognizes the normal root to be made up of 3 leaflets, supported by their own sinuses, with the sinuses themselves separated by the interleaflet triangles. The malformed root, usually found in the setting of 3 sinuses, can also be found with 2 sinuses, and very rarely with 4 sinuses. This permits description of trisinuate, bisinuate, and quadrisinuate variants, respectively. This feature then provides the basis for classification of the anatomical and functional number of leaflets present. By offering standardized terms and definitions, we submit that our classification will be suitable for those working in all cardiac specialties, whether pediatric or adult. It is of equal value in the settings of acquired or congenital cardiac disease. Our recommendations will serve to amend and/or add to the existing International Paediatric and Congenital Cardiac Code, along with the Eleventh iteration of the International Classification of Diseases provided by the World Health Organization.
  • article 0 Citação(ões) na Scopus
    Understanding yellow fever-associated myocardial injury: an autopsy study
    (2023) GIUGNI, Fernando Rabioglio; DEMARCHIAIELLO, Vera; FARIA, Caroline Silverio; POUR, Shahab Zaki; CUNHA, Marielton dos Passos; GIUGNI, Melina Valdo; PINESI, Henrique Trombini; LEDESMA, Felipe Lourenco; MORAIS, Carolina Esteves; HO, Yeh-Li; SZTAJNBOK, Jaques; FERNEZLIAN, Sandra de Morais; SILVA, Luiz Fernando Ferraz da; MAUAD, Thais; ALVES, Venancio Avancini Ferreira; SALDIVA, Paulo Hilario do Nascimento; ANTONANGELO, Leila; DOLHNIKOFF, Marisa; DUARTE-NETO, Amaro Nunes
    Background Yellow fever (YF) is a viral hemorrhagic fever, endemic in parts of South America and Africa. There is scarce evidence about the pathogenesis of the myocardial injury. The objective of this study is to evaluate the cardiac pathology in fatal cases of YF.Methods This retrospective autopsy study included cases from the Sao Paulo (Brazil) epidemic of 2017-2019. We reviewed medical records and performed cardiac tissue histopathological evaluation, electron microscopy, immunohistochemical assays, RT-qPCR for YF virus (YFV)-RNA, and proteomics analysis on inflammatory and endothelial biomarkers.Findings Seventy-three confirmed YF cases with a median age of 48 (34-60) years were included. We observed myocardial fibrosis in 68 (93.2%) patients; cardiomyocyte hypertrophy in 68 (93.2%); endothelial alterations in 67 (91.8%); fiber necrosis in 50 (68.5%); viral myocarditis in 9 (12.3%); and secondary myocarditis in 5 (6.8%). Four out of five patients with 17DD vaccine-associated viscerotropic disease presented with myocarditis. The cardiac conduction system showed edema, hemorrhages and endothelial fibrinoid necrosis. Immunohistochemistry detected CD68-positive inflammatory interstitial cells and YFV antigens in endothelial and inflammatory cells. YFV-RNA was detected positive in 95.7% of the cardiac samples. The proteomics analysis demonstrated that YF patients had higher levels of multiple inflammatory and endothelial biomarkers in comparison to cardiovascular controls, and higher levels of interferon gamma-induced protein 10 (IP-10) in comparison to sepsis (p = 0.01) and cardiovascular controls (p < 0.001) in Dunn test.Interpretation Myocardial injury is frequent in severe YF, due to multifactorial mechanisms, including direct YFV-mediated damage, endothelial cell injury, and inflammatory response, with a possible prominent role for IP-10.
  • article 0 Citação(ões) na Scopus
    Case Report: The Challenge for Diagnosis of Myocarditis and Transplant Rejection After COVID Infection in a Heart-Transplanted Adolescent
    (2023) PEGADO, Helio Milani; SIQUEIRA, Adailson; NAVARAJASEGARAN, Joshua; BENVENUTI, Luiz Alberto; CASTRO, Claudia Regina Pinheiro; ARRIETA, Santiago Raul; GUTIERREZ, Paulo Sampaio; DOLHNIKOFF, Marisa; AIELLO, Vera Demarchi; JATENE, Marcelo Biscegli; AZEKA, Estela
    Patients who have undergone organ transplantation are immunosuppressed hosts, leaving them at a higher risk of infections. SARS-COV-2 has been shown to affect heart-transplanted patients. In this case report, we present the case of a 14-year-old heart transplant recipient who developed signs and symptoms of heart failure, along with fatigue, after a COVID-19 infection. An endomyocardial biopsy was performed to diagnose rejection and to evaluate whether this was myocarditis due to SARS-COV-2. The biopsy showed intense acute cellular rejection (3R) and antibody rejection PAMR1 H+ but was negative for the SARS-CoV-2 virus. The patient received organ rejection therapy with high-dose methylprednisolone and human immunoglobulin. After treatment, her heart function recovered, with biopsy investigations showing a lower level of cellular rejection (1R).
  • article 46 Citação(ões) na Scopus
    Repair of congenital heart disease with associated pulmonary hypertension in children: what are the minimal investigative procedures? Consensus statement from the Congenital Heart Disease and Pediatric Task Forces, Pulmonary Vascular Research Institute (PVRI)
    (2014) LOPES, Antonio Augusto; BARST, Robyn J.; HAWORTH, Sheila Glennis; RABINOVITCH, Marlene; DABBAGH, Maha Al; CERRO, Maria Jesus del; IVY, Dunbar; KASHOUR, Tarek; KUMAR, Krishna; HARIKRISHNAN, S.; D'ALTO, Michele; THOMAZ, Ana Maria; ZORZANELLI, Leina; AIELLO, Vera D.; MOCUMBI, Ana Olga; SANTANA, Maria Virginia T.; GALAL, Ahmed Nasser; BANJAR, Hanaa; TAMIMI, Omar; HEATH, Alexandra; FLORES, Patricia C.; DIAZ, Gabriel; SANDOVAL, Julio; KOTHARI, Shyam; MOLEDINA, Shahin; GONCALVES, Rilvani C.; BARRETO, Alessandra C.; BINOTTO, Maria Angelica; MAIA, Margarida; HABSHAN, Fahad Al; ADATIA, Ian
    Standardization of the diagnostic routine for children with congenital heart disease associated with pulmonary arterial hypertension (PAH-CHD) is crucial, in particular since inappropriate assignment to repair of the cardiac lesions (e. g., surgical repair in patients with elevated pulmonary vascular resistance) may be detrimental and associated with poor outcomes. Thus, members of the Congenital Heart Disease and Pediatric Task Forces of the Pulmonary Vascular Research Institute decided to conduct a survey aimed at collecting expert opinion from different institutions in several countries, covering many aspects of the management of PAH-CHD, from clinical recognition to noninvasive and invasive diagnostic procedures and immediate postoperative support. In privileged communities, the vast majority of children with congenital cardiac shunts are now treated early in life, on the basis of noninvasive diagnostic evaluation, and have an uneventful postoperative course, with no residual PAH. However, a small percentage of patients (older at presentation, with extracardiac syndromes or absence of clinical features of increased pulmonary blood flow, thus suggesting elevated pulmonary vascular resistance) remain at a higher risk of complications and unfavorable outcomes. These patients need a more sophisticated diagnostic approach, including invasive procedures. The authors emphasize that decision making regarding operability is based not only on cardiac catheterization data but also on the complete diagnostic picture, which includes the clinical history, physical examination, and all aspects of noninvasive evaluation.