Showing papers by "Manuel J. Antunes published in 2019"

Systematic review and meta-analysis of surgical outcomes comparing mechanical valve replacement and bioprosthetic valve replacement in infective endocarditis.

Abstract: Background: Infective endocarditis (IE) is an infection involving either native or prosthetic heart valves, the endocardial surface of the heart or any implanted intracardiac devices. IE is a rare condition affecting 3–15 patients per 100,000 population. In-hospital mortality rates in patients with IE remain high at around 20% despite treatment advances. There is no consensus recommendation favoring either bioprosthetic valve or mechanical valve implantation in the setting of IE; patient age, co-morbidities and preferences should be considered selecting the replacement prosthesis. Methods: A systematic review and meta-analysis of studies reporting the outcomes of patients undergoing bioprosthetic or mechanical valve replacement for infective endocarditis with data extracted for overall survival, valve reinfection rates and valve reoperation. Results: Eleven relevant studies were identified, with 2,336 patients receiving a mechanical valve replacement and 2,057 patients receiving a bioprosthetic valve replacement. There was no significant difference for overall survival between patients treated with mechanical valves and those treated with bioprosthetic valves [hazard ratio (HR) 0.94, 95% confidence interval (CI): 0.73–1.21, P=0.62]. There was no significant difference in reoperation rates between patients treated with a bioprosthetic valve and those treated with a mechanical valve (HR 0.82, 95% CI: 0.34–1.98, P=0.66) and there was no significant difference in the rate of valve reinfection rates (HR 0.95, 95% CI: 0.48–1.89, P=0.89). Conclusions: The presence of infective endocarditis alone should not influence the decision of which type of valve prosthesis that should be implanted. This decision should be based on patient age, co-morbidities and preferences.

Histomorphometric analysis of the human internal thoracic artery and relationship with cardiovascular risk factors.

Abstract: In this study, we aimed at performing a histomorphometric analysis of human left internal thoracic artery (ITA) samples as well as at correlating the histomorphometric findings with the clinical profile, including risk factors and medication. Distal segments of ITA were obtained from 54 patients undergoing coronary artery bypass grafting. Histological observation was performed in paraffin-embedded transverse sections of ITA through four staining protocols: hematoxylin-eosin, van Gieson, Masson’s trichrome and von Kossa. Morphometric analysis included the intimal width (IW), medial width (MW) and intima/media ratio (IMR). No overt atherosclerotic lesions were observed. Mild calcifications were observed across the vascular wall layers in almost all samples. Multivariable linear regression analysis showed associations between IW and IMR and the following clinical variables: age, gender, kidney function expressed as eGFR and myocardial infarction history. Age (odds ratio = 1.16, P = 0.004), female gender (odds ratio = 11.34, P = 0.011), eGFR (odds ratio = 1.03, P = 0.059) and myocardial infarction history (odds ratio = 4.81, P = 0.040) were identified as the main clinical predictors for intimal hyperplasia. Preatherosclerotic lesions in ITA samples from patients undergoing coronary revascularization were associated not only with classical cardiovascular risk factors such as age and gender, but also with other clinical variables, namely kidney function and myocardial infarction history.

Unusual cause of left ventricular dysfunction in a child

Abstract: Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery is a rare congenital heart disease and a cause of myocardial ischemia during childhood. Most undiagnosed cases die in the first year of life as an extensive collateral network is essential for survival. The diagnosis requires a high index of clinical suspicion. The authors present the case of an 8-year-old black asymptomatic child referred from Cape Verde Island in order to clarify left ventricular dilatation and dysfunction with systo-diastolic turbulent flows observed at the interventricular septum. At the age of 3 months, she was diagnosed with heart failure, in the context of showing dilated cardiomyopathy. She was managed and clinically improved with anticongestive therapy, which she was still taking at the time of admission to our Center. The echocardiogram findings suggested Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery and the diagnosis was confirmed by computerized angiotomography and cardiac catheterization. The patient was successfully submitted to direct implantation of the left coronary artery into the aorta, allowing the creation of a double coronary perfusion system. This case illustrates an unusual presentation of a rare pathology that survived without a diagnosis after the first year of life. It also reinforces the importance of multimodality image screening in these cases.

Surgery for symptomatic aortic stenosis in the elderly: Still an excellent option

Abstract: As a result of the aging of populations, aortic stenosis (AS) is rapidly turning into the cardiac epidemic of the 21st century, with an estimated incidence of about 10% in patients over 80 years of age. This potentially lethal condition is still mainly treated by surgery, and patients’ general condition, both physical and mental, after the operation is perceived as being at least as important as survival, especially in elderly patients. In a paper published in this issue of the Journal, Bento et al. of the surgical group at Santa Marta Hospital in Lisbon set out to determine the impact of surgical aortic valve replacement (SAVR) on quality of life in octogenarians. In a retrospective analysis of 163 octogenarians (mean age 83 years) who underwent isolated SAVR for symptomatic severe AS between 2011 and 2015, quality of life was assessed by applying the Medical Outcomes Study Short Form (SF-36) questionnaire repeatedly up to 12 months after surgery. The authors came to the conclusion that SAVR improved the physical and mental health status of octogenarians with severe AS, and that this improvement was evident at three months and consistent at six and 12 months. Furthermore, it was observed in all eight domains of the questionnaire (physical function and performance, body pain, general and mental health, social functioning, emotional performance and vitality). The SF-36 survey

Causa rara de disfunção ventricular esquerda em idade pediátrica

Abstract: Resumo A Origem Anomala da Arteria Coronaria Esquerda da Arteria Pulmonar e uma cardiopatia congenita rara e uma causa de isquemia miocardica em idade pediatrica. A maioria dos casos nao diagnosticados morre no primeiro ano de vida, sendo necessaria a formacao de uma extensa rede de colaterais para permitir a sobrevivencia. O diagnostico nao e linear exigindo elevada suspeicao clinica. Os autores apresentam o caso de uma crianca de oito anos de idade, de raca negra, assintomatica, referenciada de Cabo Verde para esclarecimento de dilatacao e disfuncao do ventriculo esquerdo com fluxos turbulentos sistodiastolicos a nivel do septo interventricular. Dos antecedentes destacava‐se quadro de insuficiencia cardiaca diagnosticada aos tres meses de idade, com avaliacao posterior compativel com miocardiopatia dilatada. Teve melhoria clinica apos inicio de terapeutica anticongestiva que mantinha na altura da admissao no nosso Centro. Ecocardiograficamente suspeitou‐se de Origem Anomala da Arteria Coronaria Esquerda da Arteria Pulmonar, sendo este diagnostico confirmado atraves de angiotomografia computorizada e cateterismo cardiaco. A doente foi submetida, com sucesso, a implantacao direta da arteria coronaria esquerda na aorta permitindo criar um sistema de perfusao coronario duplo. Este caso ilustra uma forma incomum de uma patologia rara que sobreviveu sem diagnostico apos o primeiro ano de vida. Reforca igualmente a importância da multimodalidade de imagem nestes casos.

Atmospheric dust deposition and levels of trace elements in an industrial city with a Mediterranean climate

Abstract: This work is co-funded by the European Union through the European Regional Development Fund, based on COMPETE 2020 (Programa Operacional da Competitividade e Internacionalizacao), project ICT (UID/GEO/04683/2019) with reference POCI-010145-FEDER-007690, project GeoBioTec (UID/GEO/04035/2019) and national funds provided by Fundacao para a Ciencia e Tecnologia