Navegando por Palavras-chave "Cardiac catheterization"

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    Adaptação transcultural do Coronary Revascularisation Outcome Questionnaire para a língua portuguesa brasileira
    (Universidade Federal de São Paulo (UNIFESP), 2020-08-27) Assis, Ana Raquel Viegas de [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; Santos, Vinícius Batista [UNIFESP]; http://lattes.cnpq.br/4234078077590338; http://lattes.cnpq.br/1478157388713375; http://lattes.cnpq.br/1578730964906010; Universidade Federal de São Paulo
    Introdução: Pacientes com doenças arteriais coronarianas podem apresentar alterações na qualidade de vida devido aos sinais e sintomas desencadeados pela doença, como a precordialgia e dispneia e, consequentemente, a limitação na execução de atividades físicas. Destaca-se ainda que o tipo de tratamento para as obstruções coronarianas, quer seja cirúrgico ou percutâneo, pode influenciar na qualidade de vida destes pacientes a curto e médio prazo. Nesse sentido, foi elaborado um questionário denominado Coronary Revascularisation Outcome Questionnaire (CROQ), que avalia a qualidade de vida especificamente para esta população. Objetivo: Realizar a adaptação transcultural do Coronary Revascularisation Outcome Questionnaire – adaptado (CROQv2) para a língua portuguesa brasileira (LPB) e avaliar sua confiabilidade. Método: Estudo metodológico de adaptação transcultural para a LPB e de análise da confiabilidade das quatro versões do Coronary Revascularisation Outcome Questionnaire - adaptado (CROQv2) (CROQ-PCI v2 pre e post e, CROQ-CABG v2 pre e post). O estudo foi autorizado pela autora do questionário original e aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo (Parecer 2.105.494). Para a adaptação transcultural, foram realizadas as seguintes etapas: tradução da versão original para a LPB, síntese das traduções, retrotradução para o inglês, avaliação das equivalências semântica, idiomática, experimental e conceitual por comitê de experts, teste da versão pré-final e submissão da documentação à autora do questionário original para avaliação do processo. Para avaliação da confiabilidade, foi analisada a consistência interna por meio do alfa de Cronbach, sendo considerados aceitáveis valores superiores a 0,70. Foi também calculada a correlação item-total, sendo considerado valor de 0,20 como mínimo aceitável. Resultados: As divergências entre traduções e retrotraduções estavam relacionadas principalmente ao uso de sinônimos, ao tempo verbal ou à flexão de número. Na avaliação das equivalências, as adaptações concentraram-se em facilitar a compreensão dos itens, como mudança de jargões profissionais da área da saúde, bem como adaptação de linguagem formal para informal. Os domínios com valores de alfa de Cronbach inferiores a 0,70 foram: domínios 5 – Efeitos Adversos (0,55) e 6 – Satisfação (0,61) na versão CROQ-PCI v2 pós-Br e domínios 4 – Função Cognitiva (0,55) e 5 – Efeitos Adversos (0,61), na versão CROQ-CABG v2 pós-Br. Quanto à correlação item-total, um item do domínio 5 e um do domínio 6 da versão CROQ-PCI v2 pós-Br, um item do domínio 3 da versão CROQ-CABG v2 pré-Br e cinco itens do domínio 5 da versão CROQ-CABG v2 pós-Br obtiveram valores inferiores a 0,20. Conclusão: As versões pré procedimento (CROQ-PCI v2 pré-Br e CROQ-CABG v2 pré-Br) foram consideradas confiáveis e as versões pós procedimento (CROQ-PCI v2 pós-Br e CROQ-CABG v2 pós-Br) requerem demais análises psicométricas e com uma amostra maior, por apresentarem valores abaixo dos estabelecidos como mínimos para consistência interna em alguns domínios. Para que a versão adaptada para a língua portuguesa seja utilizada no Brasil, evidências de validade de construto e de critério devem ser obtidas.
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    Cateterismo cardíaco de exercício na hipertensão arterial pulmonar idiopática: avaliação dos mecanismos hemodinâmicos fisiopatológicos associados ao consumo máximo de oxigênio
    (Universidade Federal de São Paulo (UNIFESP), 2018-05-24) Messina, Carolina Montemor Soares [UNIFESP]; Arakaki, Jaquelina Sonoe Ota [UNIFESP]; Ferreira, Eloara Vieira Machado [UNIFESP]; Oliveira, Rudolf Krawczenko Feitoza de [UNIFESP]; http://lattes.cnpq.br/6639042770205771; http://lattes.cnpq.br/7475520878817375; http://lattes.cnpq.br/4282849546206947; http://lattes.cnpq.br/7415297086270978; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Idiopathic pulmonary arterial hypertension (IPAH) is characterized by pulmonary vascular remodeling and an associated increased pulmonary vascular resistante (PVR), which over time, can lead to right ventricular (RV) dysfunction. IPAH´s exercise tolerance, clinical evolution and survival are known to be associated with the RV adaptation to its increased afterload. However, little is known regarding the specific hemodynamic mechanisms associated with a reduced aerobic capacity in patients with severe IPAH. Objectives: To evaluate the hemodynamic mechanisms associated with peak oxygen consumption (V̇ O2) during exercise in patients with IPAH; to describe the hemodynamic patterns during exercise right heart catheterization in IPAH; and to identify the hemodynamic predictors of peak V̇ O2. Methods: Twenty patients with IPAH from the Pulmonary Hypertension Outpatient Clinic of the Federal University of São Paulo between September 2014 and March 2016 were included in the current study. All patients were submitted to contemporary pulmonary functional test, a sixminute walk test, transthoracic echocardiography, cardiopulmonary exercise testing (CPET) and resting supine right heart catheterization (RHC) followed by exercise hemodynamic assessment. Results: 85% of the patients were female, with a median age of 34[2942] and 95% were New York Heart Association functional class (NYHAFC) II or III. During exercise right heart catheterization, peak work was 30[2030] W, peak mean pulmonary arterial pressure was 76 ± 17 mmHg, peak pulmonary arterial wedge pressure was 14 ± 5 mmHg, peak PVR was 959 ± 401 dynes.s.cm5. Peak cardiac output (CO) and the peak cardiac index (CI) were 5,7 ± 1,9 L/min and 3,5 ± 1,2 L/min/m2, respectively. Peak stroke volume index (SVI) was 29 ± 12 mL/m², peak right ventricular stroke work index (RVSWI) was 29 ± 14 g/m2/bat and peak pulmonary vascular compliance (PVC) was 0,9[0,61,2] ml/mmHg. There was a positive correlation between peak V̇ O2 and peak CO (r=0,528; p=0,017), peak CI (r=0,599; p=0,005), peak SVI (r=0,494; p=0,027), peak RVSWI (r=0,543; p=0,013) and peak peripheral oxygen saturation (peak SpO2) (r=0,408; p=0,074). There was a negative correlation between peak V̇ O2 and ΔPVC (r=0,409; p=0,073). By univariate analysis, peak CO, peak CI, peak SVI, peak RVSWI, ΔPVC and peak SpO2 were predictors of peak V̇ O2. By multivariate analysis adjusted for age, only peak RVSWI (Coefficient= 0,145, CI 95% [0,0720,2219], p=0,001) and ΔPVC (Coefficient=2,510, CI 95% [4,344( 0,677)], p=0,01) remained independent predictors of peak V̇ O2. Conclusions: In IPAH, increased peak RVSWI and decreased ΔPVC during exercise are associated with a reduced peak V̇ O2. Given that RVSWI and ΔPVC represent the RV contractility and its afterload, respectively, the study findings suggest that RVpulmonary arterial coupling determine maximal aerobic capacity in IPAH.
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    Cateterismo cardíaco, diagnóstico (angiografia) e terapêutico (angioplastia) na doença arterial coronária dos pacientes diabéticos
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2007-03-01) Lima, Valter C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); FOR Hospital do Rim e Hipertensão
    Screening, diagnosis and revascularization of coronary artery disease (CAD) in type 2 diabetes mellitus are major challenges for current clinical practice. Diagnostic (angiography) and therapeutic (angioplasty) cardiac catheterization are important resources for the clinical assessment and management of coronary atherosclerosis. Anatomic peculiarities of CAD in diabetics can be well characterized by angiography, associated or not by intravascular ultrasound. The worse outcome following coronary revascularization procedures, either angioplasty or surgery, in diabetic is one of the main fields of clinical research. In spite of controversies, about one quarter of angioplasty and one third of surgical revascularization procedures are performed in diabetics. Two ongoing, large, randomized, multicentric trials are investigating the best management of CAD in diabetics. The BARI 2D trial is randomizing asymptomatic or mildly symptomatic patients with CAD for either medical therapy or revascularization (angioplasty or surgery, according to the best clinical judgment). The FREEDOM trial is randomizing stable patients with multivessel CAD for either angioplasty with drug eluting stents or surgery, with or without extracorporeal circulation. While the evidences are not available, in order to decide on the best revascularization procedure for individual patients, medical practice has been balanced according to a number of variables. Conditions that favor angioplasty: short lesions, lesions in large vessels, absence of left anterior descending artery disease, previous coronary bypass surgery and high surgical risk due to co-morbidities. Conditions that favor surgery: long lesions, lesions in small vessels, presence of left anterior descending artery disease and need for associated valve surgery.
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    Efetividade da intervenção educativa para redução da ansiedade e do estresse de pacientes que aguardam o cateterismo cardíaco: ensaio clínico randomizado
    (Universidade Federal de São Paulo (UNIFESP), 2018-05-24) Murakami, Luisa [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; http://lattes.cnpq.br/1478157388713375; http://lattes.cnpq.br/7400685742669859; São Paulo; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To assess the effectiveness of an educational intervention, guided by informative booklet, on the anxiety and stress levels of patients awaiting cardiac catheterization (CATE) and assess the relationship of sociodemographic and clinical variables with anxiety and stress. Method: This randomized, controlled and blind clinical trial was conducted in a cardiac hospital located in São Paulo, Brazil. The patients waiting for a CATE were allocated for the intervention (IG) or control group (CG) in a parallel and random manner. The IG received specific written information regarding CATE provided in a previously validated booklet, while the CG received only routine information regularly provided in the unit. Anxiety and stress were assessed, before and after the interventions, using the StateTrait Anxiety Inventory and Perceived Stress Scale, respectively, and by checking physiological effects on vital parameters. The independent variables assessed were: age, sex, race, marital status, education, cardiovascular risk factors, use of βblockers, vasodilator and angiotensin converting enzyme inhibitors, prior medical diagnosis and/or depression symptoms, prior hospitalizations and/or prior experience with percutaneous interventions, and place of hospitalization. ANOVA was used to assess altered levels of anxiety and stress in relation to time and groups. Fisher’s exact test and Student’s t test or the MannWhitney test was used to verify association of independent variables with anxiety and stress. Level of significance was established at 5% and test power was 0.90. The project was approved by the Institutional Review Board and registered in the Clinical Trials Registry. Results: A total of 128 individuals were eligible, however, the sample was composed of 122 participants, 61 of whom were assigned to the CG (59.4±8.27 years old; 82% were male) and 61 to the IG (61.9±9.67 years old; 72% were male). The groups were homogeneous, with the exception of race (CG: 62% x IG: 80% of Caucasians; p=0.044. More than half of the participants in both groups presented hypertension, sedentariness, dyslipidemia, and a prior family history of cardiovascular diseases. Most participants presented a low or moderate level of anxiety and a low level of stress in the first assessment. Levels of anxiety and stress did not change from the first to second point in time (anxiety, p=0.225 and stress, p=0.696), in terms of interaction (anxiety, p=0.183 and stress, p=0.444), or in terms of groups (anxiety, p=0.341 and stress, p=0.624). Anxiety presented a significantly relationship with the youngest participants (p=0.033), who reported stress (p=0.046) and former smoking (p=0.013). Stress was related with being a smoker (p=0.001) and being younger (p=0.019). Conclusion: This study’s hypothesis that an educational intervention provided through an informative booklet would decrease anxiety and stress among patients awaiting CATE was not confirmed. Anxiety was related to age, stress and smoking, while stress was related to smoking and age.
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    Elaboração e validação de um manual informativo sobre cateterismo cardíaco
    (Univ Fed Sao Paulo, Dept Enfermagen, 2016) Maciel, Bianca Silva [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]
    Objective: To elaborate and validate an information manual for cardiac catheterization. Methods: This was a methodological study. The manual was elaborated based on experience of researchers and data from the literature. The manual was validated by 8 nurses by using the Delphi technique
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    Experiência inicial da Universidade Federal de São Paulo no desenvolvimento e aplicação do implante valvar aórtico transcateter
    (Universidade Federal de São Paulo (UNIFESP), 2009-11-25) Santos, Diego Felipe Gaia dos [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for aortic position implant. METHOD: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median age was 75,5 years. Median Logistic EuroSCORE was 43,7%. Four patients presented with disfunctional bioprosthesis, remainig ones presented calcified aortic stenosis (peak transvalvular gradient 79,7 mmHg). After minithoracotomy and under echocardiograph and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiograph and angiograph controls were performed and the patients were referred to ICU. RESULTS: Implant was feasible in 13 cases. There were no intra-operative deaths. Mortality was 42%. Median peak transvalvular aortic gradient reduced to 25,0 mmHg, and left ventricular function improved in the first 7 post operative days. Paravalvular aortic regurgitation was mild and present in most cases. Platelet count significantly decreased after procedure, but returned to normal values after 30 days. CONCLUSION: The transapical implantation of catheter-mounted bioprosthesis was a feasible procedure. Technical details and learning curve require further discussion.
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    Implante transcateter de bioprótese valvular pulmonar: revisão sistemática da literatura
    (Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista - SBHCI, 2013-06-01) Botrel, Tobias Engel Ayer; Clark, Otávio Augusto C.; Queiroga, Marcelo C.; Rossi Filho, Raul I.; Pilla, Carlo B.; Arrieta, Raul S.; Cristovão, Salvador [UNIFESP]; Silva, Célia C. [UNIFESP]; Esteves, Cesar A.; Oliveira, Edmundo Clarindo; Simões, Luiz Carlos; Chamié, Francisco; Neves, Juliana; Max, Roberto; Pedra, Carlos A. C.; Evidências - Credibilidade Científica; Hospital da Unimed João Pessoa; Fundação Universitária de Cardiologia Instituto de Cardiologia Setor de Cardiologia Intervencionista em Cardiopatias Congênitas; Complexo Hospitalar Santa Casa de Porto Alegre Serviço de Cardiologia Pediátrica e Cardiologia Intervencionista; Hospital Beneficência Portuguesa de São Paulo Setor de Intervenções em Cardiopatias Congênitas; Universidade Federal de São Paulo (UNIFESP); Instituto Dante Pazzanese de Cardiologia Seção Médica de Intervenções em Valvopatias Adquiridas; Universidade Federal de Minas Gerais Hospital de Clinicas Departamento de Cardiopatias Congênitas; Hospital Laranjeiras Instituto Nacional de Cardiologia Serviço de Cardiologia da Criança e do Adolescente; Hospital Federal dos Servidores do Estado Setor de Cardiologia Intervencionista dos Defeitos Estruturais e Congênitos; Instituto de Medicina Integral Prof. Fernando Figueira Setor de Hemodinâmica em Cardiopatias Congênitas; Hospital Biocor Departamento de Cardiologia Pediátrica Intervencionista; Instituto Dante Pazzanese de Cardiologia Seção Médica de Intervenções em Cardiopatias Congênitas
    Surgical repair of some complex congenital heart diseases involves reconstruction of the right ventricular outflow tract using homografts, bioprostheses, bovine jugular grafts or other valved conduits between the right ventricle and the main pulmonary artery. Although these surgical procedures may be performed with low mortality rates, the life span of these implanted valves or conduits is usually short (< 10 years) due to either degeneration and/or calcification. Variable degrees of pulmonary stenosis, often associated with pulmonary insufficiency, are consequences of conduit degeneration. In 2000, Bonhoeffer et al. were the first to report the transcatheter pulmonary valve implantation (TPVI) of a bioprosthetic pulmonary valve later named Melody® valve (Medtronic, Minneapolis, USA). The technique was initially developed to limit the need for multiple surgical procedures, and, ultimately, to work as a surrogate of a new surgical valve replacement. Subsequent clinical studies in Europe and the United States confirmed the safety and efficacy of this technique in a larger number of patients. Since the National Sanitary Surveillance Agency (Agência Nacional de Vigilância Sanitária - Anvisa) granted approval for clinical use of the Melody® transcatheter pulmonary biological valve in February 2103, we deemed that a judicious assessment of this new technology was timely and necessary before the widespread use in our country. The objective of this study was to perform a systematic literature review on the use of TPVI in patients with dysfunctional homografts, valved conduits and bioprostheses implanted surgically in the right ventricular outflow tract.
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    Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures
    (Oxford Univ Press, 2017) Gaia, Diego Felipe [UNIFESP]; Braz, Ademir Massarico [UNIFESP]; Simonato, Matheus [UNIFESP]; Dvir, Danny; Breda, Joao Roberto [UNIFESP]; Ribeiro, Gustavo Calado; Ferreira, Carolina Baeta [UNIFESP]; Marcondes Souza, Jose Augusto [UNIFESP]; Buffolo, Enio [UNIFESP]; Palma, Jose Honorio [UNIFESP]
    OBJECTIVES: Reoperative procedure for the treatment of a failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve (ViV) transcatheter mitral valve implant offers an alternative less-invasive approach, reducing morbidity and mortality. The objective of this paper was to evaluate the mitral ViV approach using the Braile Inovare prosthesis. METHODS: The transcatheter balloon-expandable Braile Inovare prosthesis was used in 12 cases. Procedures were performed in a hybrid operating room, under fluoroscopic and echocardiographic control. Through left minithoracotomy, the prostheses were implanted through the cardiac apex. Serial echocardiographic and clinical examinations were performed. Follow-up varied from 1 to 30 months. RESULTS: A total of 12 transapical mitral ViV procedures were performed. Patients had a mean age of 61.6 +/- 9.9 years and 92% were women. Mean logistic EuroSCORE was 20.1%. Successful valve implantation was possible in all cases. In one case, a right lateral thoracotomy was performed for the removal of an embolized prosthesis. There was no operative mortality. Thirty-day mortality was 8.3%. Ejection fraction was preserved after the implant (66.7%
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    Tempo de compressão da artéria radial pós-cinecoronariografia : influência sobre homostasia e ocorrências de complicações vasculares
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Campos, Maria Aparecida de Carvalho [UNIFESP]; Avelar, Ariane Ferreira Machado [UNIFESP]; Peterlini, Maria Angelica Sorgini [UNIFESP]; http://lattes.cnpq.br/1599622257763420; http://lattes.cnpq.br/8919300907658980; http://lattes.cnpq.br/8700431117009553; Universidade Federal de São Paulo (UNIFESP)
    Transradial access is the safest technique to perform arterial percutaneous diagnostic and interventional procedures. Mechanical devices are used for effective and in shortest time patent hemostasis, increasing late radial artery patency. However, custom dressing gauze compression is widely used in developing countries for cost containment with ideal time for hemostasis, effectiveness of patent occlusion and effect on late radial artery occlusion largely unknown. Objective: We aimed to compare two different compression times of the radial artery after elective coronary angiography using customized compressive dressing regarding the achievement of hemostasis and vascular immediate and late complications. Method: In a prospective, randomized and controlled study in patients submitted to transradial elective coronary angiography, which were allocated to two study groups: compressive dressing maintained for 30 minutes (G30) or compressive dressing maintained for 60 minutes (G60). Variables related to patients, procedure, occurrence of hemostasis and complications were assessed. Radial artery patency was evaluated with Doppler vascular ultrasonography at the time of removal of the compression as well as at 30 days of follow-up. Results: The sample was consisted of 152 patients in the G30 and 151 in the G60, homogeneously distributed in those two studied groups, which have been through demographic, procedural, hemostasis and also vascular complications characteristics. Hemostasis was obtained in 76.3% from the G30 patients and in 84.2% from the G60 patients in the first evaluation. The occurrence of type I and II hematoma was identified in 14.5% from G30 and 20.5% of patients from the G60 while the immediate radial artery occlusion was found in 13.2% from G30 patients and in 11.9% % from the G60. In the 30-day evaluation, 18 late occlusions were identified, 7 (5.5%) from the G30 and 11 (8.2%) from the G60.Conclusion: The different times of radial artery compression after coronary angiography have not significantly influenced the occurrence of hemostasis and vascular immediate and late complications.
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    Tricuspid transcatheter valve-in-valve: an alternative for high-risk patients
    (Oxford Univ Press Inc, 2012-03-01) Gaia, Diego Felipe [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Souza, Jose Augusto Marcondes de [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Tricuspid valve disease is not uncommon. Some patients with tricuspid valve disease require tricuspid replacement with bioprosthesis and, over time, may require re-interventions. Transcatheter tricuspid valve-in-valve approach has emerged as an alternative to treat dysfunctional bioprosthesis. in this article, we report a case of a patient with four previous cardiac interventions presenting with tricuspid bioprosthesis dysfunction. the patient was treated with the transcatheter transatrial tricuspid valve-in-valve procedure. the procedure was successful with no residual leakage and a non-significant mean gradient. the patient recovered well and was discharged in 1 week. the procedure is a feasible alternative for high-risk patients. Selection and postoperative care are crucial for the outcome.