MARIO TERRA FILHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina - Líder
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Use of medical therapies before pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients with severe hemodynamic impairment(2020) CASTRO, Marcela Araujo; PILOTO, Bruna; FERNANDES, Caio Julio Cesar dos Santos; JARDIM, Carlos; SALIBE FILHO, William; OLEAS, Francisca Gavilanes; ALVES, Jose Leonidas; MORINAGA, Luciana Tamie Kato; HOETTE, Susana; TERRA FILHO, Mario; FREITAS FILHO, Orival; JATENE, Fabio Biscegli; SOUZA, RogerioChronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, characterized by non-resolving fibro-thrombotic obstructions of large pulmonary arteries. Pulmonary endarterectomy (PEA) is the treatment of choice for the disease, significantly improving survival. Patients with worse hemodynamic profile have worse prognosis after surgery, raising the question of whether the use of medical therapy prior to surgery to optimize hemodynamics could improve outcomes. The aim of this study was to evaluate the role of medical therapy pre-PEA, according to the hemodynamic profile at the diagnosis. We retrospectively analyzed all patients submitted to PEA, from January 2013 to December 2017. Functional, clinical and hemodynamic data were collected to evaluate the main prognostic determinants. Patients were stratified according to the hemodynamic severity and use of targeted therapies prior to surgery. A total of 108 patients were included. Thirty-five patients (32,4%) used targeted therapy pre-PEA. The use of medical therapy delayed the surgical procedure by about 7 months. There was no difference in overall survival between patients that received targeted therapy and those treated only with supportive therapy (87.8% vs 80.3%, respectively, p = 0.426). Nevertheless, when analyzing the group of patients with severe hemodynamic impairment, defined by low cardiac output(< 3.7L/min) at baseline, patients treated with targeted therapies presented a significantly better one-year survival. In higher-risk CTEPH patients, characterized by the presence of low cardiac output, the use of targeted therapies prior to PEA was associated with better outcome, suggesting a potential role for pre-operative use of medical treatment in this particular subgroup.
- Loss of response to calcium channel blockers after long-term follow up in idiopathic pulmonary arterial hypertension(2020) PILOTO, Bruna; FERNANDES, Caio; JARDIM, Carlos; CASTRO, Marcela; SALIBE-FILHO, William; ALVES-JR, Jose Leonidas; MORINAGA, Luciana; SOBRAL-ALVES, Juliana; HOETTE, Susana; TERRA-FILHO, Mario; SOUZA, Rogerio
conferenceObject Cavities Lesions In Patients With Chronic Thromboembolic Pulmonary Hypertention(2017) OLIVEIRA, E. P.; FERNANDES, C. C.; OLEAS, F. G.; ALVES JUNIOR, J. L.; ATHANAZIO, R. A.; SALES, R. K. B.; MORAIS, I. O.; SALIBE FILHO, W.; JARDIM, C. V. P.; TERRA FILHO, M.; SOUZA, R.- The use of new anticoagulants in CTEPH(2017) GAVILANES, Francisca; ALVES JR., Jose Leonnidas; FERNANDES, Caio J. C.; PRADA, Luis F. L.; SALIBE FILHO, William; TERRA FILHO, Mario; JARDIM, Carlos; SOUZA, Rogerio
- Selectins and Platelet-Derived Growth Factor (PDGF) in Schistosomiasis-Associated Pulmonary Hypertension(2014) LAPA, Monica; ACENCIO, Milena M. P.; FARIAS, Alberto Q.; TEIXEIRA, Lisete R.; FERNANDES, Caio J. C.; JARDIM, Carlos P.; TERRA-FILHO, MarioThe aim of this study was to evaluate the expression profiles of the relevant selectins and PDGF in schistosomiasis-associated pulmonary hypertension. Patients with three distinct clinical profiles were enrolled in the study: IPAH(n = 11), schistosomiasis-associated PH (Sch-PH))(n = 13), and schistosomiasis without PH (Sch) (n = 13). Healthy volunteers, were recruited as a control group(n = 13). Echocardiography was performed in all groups, and the PH patients underwent right heart catheterization. Plasma soluble adhesion molecules E- and P-Selectin, PDGF-AB, PDGF-BB were determined by ELISA. E-selectin was significantly increased in the IPAH group compared with the other groups [the control, Sch + PH and Sch groups) (p < 0.001) (Fig. 2)]. P-selectin was lower in Sch (20.2 + 8.9 x 103 pg/mL) as compared to the control, (43 16.8 x 103 pg/mL), IPAH (35.8 7.8 x 103 pg/mL), and Sch + PH (36.8 +/- A 15.7 x 103 pg/mL) (p = 0.005) groups. Serum PDGF-BB levels were higher in the control group (8.9 +/- A 4.8 x 103 pg/mL) compared with the IPAH (3.7 +/- A 2.17 x 103 pg/mL), Sch + PH (5.2 +/- A 3.7 x 103 pg/mL) and Sch (2.4 +/- A 1.7 x 103 pg/mL) groups (p < 0.05). PDGF-AB levels were also higher in the control group (25.6 +/- A 8.6 x 103 pg/mL), compared with the other three groups, being the Sch group the one with lower serum levels of this marker (11.4 +/- A 8.6 x 103 pg/mL) (p = 0.006). In conclusion, vascular inflammation in schistosomiasis, with or without PH, is different from IPAH suggesting distinct pathophysiological mechanisms associated with the development of pulmonary hypertension.
- Lung Cavities in Chronic Thromboembolic Pulmonary Hypertension(2020) FERNANDES, Caio Julio Cesar dos Santos; OLIVEIRA, Ellen Pierre de; SALIBE-FILHO, Willian; TERRA-FILHO, Mario; JARDIM, Carlos Vianna Poyares; KATO-MORINAGA, Luciana Tamie; HOETTE, Susana; SOUZA, Rogerio deOBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by recanalized thromboembolic material. CTEPH has a wide range of radiologic presentations. Commonly, it presents as main pulmonary artery enlargement, peripheral vascular obstructions, bronchial artery dilations, and mosaic attenuation patterns. Nevertheless, other uncommon presentations have been described, such as lung cavities. These lesions may be solely related to chronic lung parenchyma ischemia but may also be a consequence of concomitant chronic infectious conditions. The objective of this study was to evaluate the different etiologies that cause lung cavities in CTEPH patients. METHODS: A retrospective data analysis of the medical records of CTEPH patients in a single reference PH center that contained or mentioned lung cavities was conducted between 2013 and 2016. RESULTS: Seven CTEPH patients with lung cavities were identified. The cavities had different sizes, locations, and wall thicknesses. In two patients, the cavities were attributed to pulmonary infarction; in 5 patients, an infectious etiology was identified. CONCLUSION: Despite the possibility of being solely associated with chronic lung parenchyma ischemia, most cases of lung cavities in CTEPH patients were associated with chronic granulomatous diseases, reinforcing the need for active investigation of infectious agents in this setting.
- Update on the Treatment of Pulmonary Arterial Hypertension(2021) FERNANDES, Caio J.; CALDERARO, Daniela; ASSAD, Ana Paula Luppino; SALIBE-FILHO, William; KATO-MORINAGA, Luciana Tamie; HOETTE, Susana; PILOTO, Bruna; CASTRO, Marcela Araujo; LISBOA, Roberta Pontes; SILVA, Taysa Antonia Felix da; MARTINS, Murillo de Araujo; ALVES-JR, Jose L.; JARDIM, Carlos; TERRA-FILHO, Mario; SOUZA, Rogerio deIn the last decades, important advances have been made in the treatment of pulmonary arterial hypertension (PAH), a severe, progressive, incurable, and potentially fatal disease. For an adequate therapy, correct hemodynamic diagnosis and etiology classification are fundamental. Many etiologies - rheumatic disease, portal hypertension, congenital heart diseases, schistosomiasis - require specific measures, in addition to drug therapy for PAH. The specific therapy for PAH is based on medications that act on three pathophysiological pathways - prostacyclin, endothelin, and nitric oxide pathways. These drugs have multiple presentations (oral, intravenous, subcutaneous, and inhaled) and have changed the history of PAH. This review presents an overview of drug therapy strategies and different forms and peculiarities of PAH.
- Brazilian Thoracic Society recommendations for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension(2020) FERNANDES, Caio Julio Cesar dos Santos; OTA-ARAKAKI, Jaquelina Sonoe; CAMPOS, Frederico Thadeu Assis Figueiredo; CORREA, Ricardo de Amorim; GAZZANA, Marcelo Basso; JARDIM, Carlos Vianna Poyares; JATENE, Fábio Biscegli; ALVES JUNIOR, Jose Leonidas; RAMOS, Roberta Pulcheri; TANNUS, Daniela; TELES, Carlos; TERRA FILHO, Mario; WAETGE, Daniel; SOUZA, RogerioABSTRACT Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious and debilitating disease caused by occlusion of the pulmonary arterial bed by hematic emboli and by the resulting fibrous material. Such occlusion increases vascular resistance and, consequently, the pressure in the region of the pulmonary artery, which is the definition of pulmonary hypertension. The increased load imposed on the right ventricle leads to its progressive dysfunction and, finally, to death. However, CTEPH has a highly significant feature that distinguishes it from other forms of pulmonary hypertension: the fact that it can be cured through treatment with pulmonary thromboendarterectomy. Therefore, the primary objective of the management of CTEPH should be the assessment of patient fitness for surgery at a referral center, given that not all patients are good candidates. For the patients who are not good candidates for pulmonary thromboendarterectomy, the viable therapeutic alternatives include pulmonary artery angioplasty and pharmacological treatment. In these recommendations, the pathophysiological bases for the onset of CTEPH, such as acute pulmonary embolism and the clinical condition of the patient, will be discussed, as will the diagnostic algorithm to be followed and the therapeutic alternatives currently available.
- Use of direct oral anticoagulants for chronic throm-boembolic pulmonary hypertension(2018) GAVILANES-OLEAS, Francisca Alexandra; ALVES-JR, Jose Leonidas; FERNANDES, Caio Julio Cesar; PRADA, Luis Felipe Lopes; SALIBE-FILHO, William; TERRA-FILHO, Mario; MORINAGA, Luciana; HOETTE, Susana; JARDIM, Carlos; SOUZA, RogerioOBJECTIVES: Chronic thromboembolic pulmonary hypertension is one of the most prevalent forms of pulmonary hypertension and is a major complication of acute pulmonary embolism. One mainstay of chronic thromboembolic pulmonary hypertension treatment is lifelong anticoagulation. The recent advent of direct oral anticoagulants for acute pulmonary embolism treatment has provided a viable and effective alternative for treating this condition. However, little is known about the efficacy of this new class of drugs for treating chronic thromboembolic pulmonary hypertension. We aimed to evaluate the safety and efficacy of direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension. METHODS: A cohort of chronic thromboembolic pulmonary hypertension patients who initiated treatment with direct oral anticoagulants between June 2015 and November 2016 were enrolled in this study. RESULTS: Sixteen patients used rivaroxaban, three used dabigatran and one used apixaban for a mean follow-up of 20.9 months. The mean age was 51 years, and eighteen patients were classified as functional class Eight patients underwent a pulmonary endarterectomy and exhibited clinical, hemodynamic and functional improvement and currently continue to use direct oral anticoagulants. No episode of venous thromboembolism recurrence was identified during the follow-up period, but there was one episode of major bleeding after a traumatic fall. CONCLUSIONS: Although direct oral anticoagulants appear to be a safe and effective alternative for treating chronic thromboembolic pulmonary hypertension, larger studies are needed to support their routine use.
bookPart Hipertensão Pumonar(2016) SOUZA, Rogério; JARDIM, Carlos Viana Poyares; FERNANDES, Caio Júlio César dos Santos; FONSECA, Guilherme Henrique Hencklain; TERRA FILHO, Mário