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1.
Cardiovasc Pathol ; 47: 107207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32179251

RESUMO

Factors causing the weakness that underlies thoracic aorta aneurysms and dissections are not well known. Based on the findings of apoptosis and ischemic-like necrosis, we hypothesized a possible role for mitochondrial disturbances in the pathogenesis of these diseases. To evaluate if mitochondria at the aortic medial layer are damaged, samples of ascending aortas with aneurysms (n = 6), acute dissections (n = 5), and hypertensive (n = 9) and normotensive controls (n = 7) were analyzed by transmission electron microscopy. Number of mitochondria, areas of cytoplasm, and areas of mitochondria were measured, and area percentage of the cytoplasm corresponding to mitochondria, their number by unit of area, and their mean area were calculated in randomly taken photographs. Data were compared using one-way analysis of variance or Kruskal-Wallis tests. Significant differences (P ≤ 0.05) were found in the number of mitochondria and their mean area, showing opposite results: the number increased and the mean area decreased from normotensive controls to hypertensive controls to acute dissections to aneurysms, although post hoc tests showed that only the differences between the aneurysms and either both controls (number of mitochondria/mm2: 10.37 in normotensive controls, 15.61 in hypertensive controls, and 43.67 in aneurysms) or normotensive controls only (mean area: 2800.15 in normotensive controls vs 894.91 µm2 in aneurysms) were significant. In conclusion, there are more, smaller mitochondria in ascending aorta aneurysms. This pattern possibly corresponds to dysfunctional mitochondria, indicating that alterations in the dynamics of these organelles may play a role in the pathogenesis of thoracic aorta aneurysms and dissections.


Assuntos
Aneurisma Dissecante/patologia , Aorta Torácica/ultraestrutura , Aneurisma da Aorta Torácica/patologia , Mitocôndrias/ultraestrutura , Apoptose , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Dinâmica Mitocondrial
7.
Autops Case Rep ; 7(3): 3-6, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29043203
11.
Braz J Cardiovasc Surg ; 32(3): 156-161, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28832792

RESUMO

Objective:: To present the results of a new experimental device developed to facilitate the transapical access in endovascular treatment of structural heart diseases. It aims to reduce the risk of bleeding and complications in this type of access and demonstrate the device as a safe, fast and effective alternative. Methods:: CorPoint is composed of three parts: introducer, base with coiled spring, and closing capsule. By rotating movements, the spring is introduced into the myocardium and progressively approaches the base to the surface of the heart. Guidewires and catheters are inserted through the hollow central part and, at the end of the procedure, the capsule is screwed over the base, therefore stopping any bleeding. Results:: The device was implanted in 15 pigs, weighing 60 kg each, through an anterolateral thoracotomy, while catheters were introduced and guided by fluoroscopy. All animals had minimal bleeding; introducers with diameter up to 22 Fr were used and various catheters and guidewires were easily handled. After finishing the procedure, the closing capsule was attached and no bleeding was observed at the site. Conclusion:: This new device has proved effective, fast and secure for the transapical access. This shows great potential for use, especially by ensuring an easier and direct access to the mitral and aortic valves; the shortest distance to be traveled by catheters; access to the ascending and descending aorta; decreased bleeding complications; decreased surgical time; and the possibility of allowing the technique to evolve and become totally percutaneous.


Assuntos
Valva Aórtica/cirurgia , Cateterismo Cardíaco/instrumentação , Desenho de Equipamento/métodos , Ventrículos do Coração/cirurgia , Valva Mitral/cirurgia , Substituição da Valva Aórtica Transcateter/instrumentação , Animais , Valva Aórtica/patologia , Perda Sanguínea Cirúrgica , Cateterismo Cardíaco/métodos , Feminino , Ventrículos do Coração/patologia , Masculino , Valva Mitral/patologia , Modelos Animais , Reprodutibilidade dos Testes , Fatores de Risco , Suínos , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/métodos
14.
Rev. bras. cir. cardiovasc ; 32(3): 156-161, May-June 2017. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-897908

RESUMO

Abstract Objective: To present the results of a new experimental device developed to facilitate the transapical access in endovascular treatment of structural heart diseases. It aims to reduce the risk of bleeding and complications in this type of access and demonstrate the device as a safe, fast and effective alternative. Methods: CorPoint is composed of three parts: introducer, base with coiled spring, and closing capsule. By rotating movements, the spring is introduced into the myocardium and progressively approaches the base to the surface of the heart. Guidewires and catheters are inserted through the hollow central part and, at the end of the procedure, the capsule is screwed over the base, therefore stopping any bleeding. Results: The device was implanted in 15 pigs, weighing 60 kg each, through an anterolateral thoracotomy, while catheters were introduced and guided by fluoroscopy. All animals had minimal bleeding; introducers with diameter up to 22 Fr were used and various catheters and guidewires were easily handled. After finishing the procedure, the closing capsule was attached and no bleeding was observed at the site. Conclusion: This new device has proved effective, fast and secure for the transapical access. This shows great potential for use, especially by ensuring an easier and direct access to the mitral and aortic valves; the shortest distance to be traveled by catheters; access to the ascending and descending aorta; decreased bleeding complications; decreased surgical time; and the possibility of allowing the technique to evolve and become totally percutaneous.

16.
JAMA Cardiol ; 2(2): 190-199, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-27926769

RESUMO

Importance: In Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), interventions reducing the progression of myocardial disease could affect survival. Objective: To assess the effect of early angiotensin-converting enzyme (ACE) inhibitor therapy in patients with normal left ventricular function on the progression of myocardial fibrosis (MF) identified on cardiovascular magnetic resonance (CMR). Design, Setting, and Participants: A randomized clinical trial conducted in 2 centers included 76 male patients with DMD or BMD undergoing 2 CMR studies with a 2-year interval for ventricular function and MF assessment. In a non-intent-to-treat trial, 42 patients with MF and normal left ventricular ejection fraction (LVEF) were randomized (1:1) to receive or not receive ACE inhibitor therapy. The study was conducted from June 26, 2009, to June 30, 2012. Data analysis was performed from June 30, 2013, to October 3, 2016. Interventions: Randomization (1:1) to receive or not receive ACE inhibitor therapy. Main Outcomes and Measures: Primary outcome was MF progression from baseline to the 2-year CMR study. Results: Of the 76 male patients included in the study, 70 had DMD (92%) and 6 had BMD (8%); mean (SD) age at baseline was 13.1 (4.4) years. Myocardial fibrosis was present in 55 patients (72%) and LV systolic dysfunction was identified in 13 patients (24%). Myocardial fibrosis at baseline was an independent indicator of lower LVEF at follow-up (coefficient [SE], -0.16 [0.07]; P = .03). Among patients with MF and preserved LVEF (42 [55%]), those randomized (21 patients in each arm) to receive ACE inhibitors demonstrated slower MF progression compared with the untreated group (mean [SD] increase of 3.1% [7.4%] vs 10.0% [6.2%] as a percentage of LV mass; P = .001). In multivariate analysis, ACE inhibitor therapy was an independent indicator of decreased MF progression (coefficient [SE], -4.51 [2.11]; P = .04). Patients with MF noted on CMR had a higher probability of cardiovascular events (event rate, 10 of 55 [18.2%] vs 0 of 21 [0%]; log-rank P = .04). Conclusions and Relevance: In this 2-year, follow-up, randomized clinical trial of patients with Duchenne or Becker muscular dystrophy whose LVEF was preserved and MF was present as determined on CMR, ACE inhibitor therapy was associated with significantly slower progression of MF. The presence of MF was associated with worse patient prognosis. Trial Registration: clinicaltrials.org Identifier: NCT02432885.


Assuntos
Cardiomiopatias/etiologia , Distrofia Muscular de Duchenne/complicações , Miocárdio/patologia , Sistema de Registros , Adolescente , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Biópsia , Cardiomiopatias/diagnóstico , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/fisiopatologia , Criança , Progressão da Doença , Feminino , Fibrose/diagnóstico , Fibrose/tratamento farmacológico , Fibrose/etiologia , Fibrose/fisiopatologia , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Distrofia Muscular de Duchenne/diagnóstico , Prognóstico , Estudos Prospectivos , Volume Sistólico/fisiologia
17.
Clin Rheumatol ; 36(1): 205-208, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27604701

RESUMO

The objective of this study was to demonstrate the presence of mycobacterial nucleic acid sequences in peripheral blood and arteries from patients with Takayasu arteritis (TA). Polymerase chain reaction was performed to detect mycobacterial DNA from three different nucleic acid sequences including the insertion sequence (IS) 6110, the 65-kDa heat shock protein gene (HSP65), and the 16S ribosomal RNA (rRNA) gene in peripheral blood from 32 TA patients and in arterial specimens from 10 TA patients. Twenty-eight HIV-negative patients with pulmonary tuberculosis prior to therapy were tested for IS6110 in peripheral blood as positive controls, and 24 blood donors were evaluated as healthy controls (HC). All TA patients were negative for the insertion sequence IS6110 and for HSP65 and 16S rRNA genes in blood samples and in arterial specimens. IS6110 sequence was found in peripheral blood from 22 (78.5 %) patients with pulmonary tuberculosis but not in HC. In conclusion, the strategy of mycobacterial-specific nucleic acid amplification in the peripheral blood and arterial specimens of TA patients was unable to lend support to the association between TA and tuberculosis long suggested in the literature.


Assuntos
Artérias/microbiologia , DNA Bacteriano/sangue , Arterite de Takayasu/microbiologia , Adolescente , Adulto , Proteínas de Bactérias/genética , Estudos de Casos e Controles , Chaperonina 60/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , Arterite de Takayasu/sangue , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/epidemiologia
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