Browsing by Author "Matos, V"
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- Complications of endomyocardial biopsy in heart transplant patients: a retrospective study of 2117 consecutive proceduresPublication . Saraiva, F; Matos, V; Gonçalves, L; Antunes, MJ; Providência, LABACKGROUND: Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of graft rejection after heart transplantation (HT). Our purpose was to evaluate the rate of complications of this invasive procedure. METHODS: This was a retrospective study of 175 patients, who were transplanted between November 2003 and October 2010 and survived more than 1 month after surgery. We evaluated the number of inconclusive EMB and described the incidence, nature, and subsequent management of several complications associated with this procedure. RESULTS: Over a period of approximately 7 years, we performed 2217 EMB yielding 4972 specimens, namely, an average of 2.3 fragments per procedure. The majority of EMBs (95.3%) were performed by the femoral approach. Only 12 EMB (0.57%) were inconclusive. The overall complication rate was 0.71%. During puncture, one patient experienced a vasovagal reaction and another one, a femoral artery false aneurysm. During the biopsy, there was one case of cardiac perforation with tamponade, two cases of supraventricular tachycardia, and three atrioventricular conduction abnormalities. In 19 patients, histological analysis revealed chordal tissue, but only two patients developed mild tricuspid regurgitation. We observed five cases of coronary artery fistulae. The clinical outcomes were favorable in all cases. CONCLUSION: EMB proved to be a suitable, safe method to monitor rejection after HT.
- Coronary fistulas after cardiac transplantationPublication . Saraiva, F; Matos, V; Gonçalves, L; Antunes, MJ; Providência, LA
- Embolia coronária aguda em portadora de prótese aórtica mecânica: caso clínicoPublication . Saraiva, F; Matos, V; Gonçalves, L; Providência, LAEmbolic myocardial infarction is a rare entity, which is often difficult to diagnose, and there is little agreement on its treatment. Patients with prosthetic valves are considered an important risk group. A 71-year-old woman with a mechanical aortic prosthesis was admitted with anterior ST segment elevation myocardial infarction after two hours of symptoms. Emergency angiography revealed an image suggestive of a large thrombus at the level of the proximal left anterior descending artery. After several attempts to perform thrombus aspiration and balloon dilatation, TIMI 2 flow was obtained. Effective anticoagulation was immediately started and the clinical outcome was favorable. Angiographically normal coronary arteries one year previously, the patient's discontinuation of warfarin and the present angiographic appearance of the culprit lesion suggested an embolic etiology. This cause is often underdiagnosed and associated with ineffective anticoagulation. Its treatment therefore requires educational intervention.
- Invasive strategy in non-ST elevation acute coronary syndromes: risks and benefits in an elderly populationPublication . Lourenço, C; Teixeira, R; António, N; Saraiva, F; Baptista, R; Jorge, E; Monteiro, S; Gonçalves, F; Monteiro, P; Matos, V; Calisto, J; Faria, H; Gonçalves, L; Freitas, M; Providência, LA
- Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomesPublication . Jorge, E; Baptista, R; Faria, H; Calisto, J; Matos, V; Gonçalves, L; Monteiro, P; Providência, LAINTRODUCTION AND AIM: Percutaneous mitral valvuloplasty (PMV) is an effective treatment option for mitral stenosis (MS), but its success is assessed on the basis of clinical and echocardiographic outcomes in studies with relatively short follow-up. We aimed to characterize a cohort of patients undergoing PMV with long-term follow-up and to determine independent predictors of post-PMV mitral re-intervention and event-free survival. METHODS: We studied 91 consecutive patients with MS who underwent PMV with a median clinical follow-up duration of 99 months. Two endpoints were considered: post-PMV mitral re-intervention (PMV or mitral surgery) and a composite clinical events endpoint including cardiovascular death, mitral valve re-intervention and hospital admission due to decompensated heart failure. We compared patients who required post-PMV mitral re-intervention with those who did not during follow-up. RESULTS: The study population included 83.5% females and mean age was 48.9±13.9 years. The 1-, 3-, 5-, 7- and 9-year rates of clinical event-free survival were 93.0±2.8%, 86.0±3.9%, 81.0±4.4%, 70.6±5.6%, and 68.4±5.8%, respectively. The 1-, 3-, 5-, 7- and 9-year rates of mitral re-intervention-free survival were 98.8±1.2%, 97.5±1.7%, 92.1±3.1%, 85.5±4.5%, and 85.5±4.5%, respectively. The median time to mitral re-intervention was 6.2 years. Patients who required mitral re-intervention during follow-up were younger (43.3 vs. 51.2 years, p=0.04) and had higher pre- and post-PMV mitral gradient (14.9 vs. 11.5mmHg, p=0.02 and 6.4 vs. 2.1mmHg, p<0.001) and higher post-PMV mean pulmonary artery pressure (mPAP) (30.0 vs. 23.2mmHg, p=0.01). In a Cox proportional hazards model, mPAP ≥25mmHg was the sole predictor of both mitral re-intervention (HR 5.639 [1.246-25.528], p=0.025) and clinical events (HR 3.622 [1.070-12.260], p=0.039). CONCLUSION: In our population, immediate post-PMV mPAP was the sole predictor of post-PMV mitral intervention. These findings may help identify patients in need of closer post-PMV follow-up.
- Optical Coherence Tomography-Guided Full Plastic Jacket in Spontaneous Coronary Artery DissectionPublication . Ramalho, AR; Silva Marques, JC; Oliveira Santos, M; Matos, V
- Results of the routine use of 4F catheters for diagnostic catheterization in a cath labPublication . Lourenço, C; António, N; Santos, L; Teixeira, R; Costa, S; Matos, V; Calisto, J; Faria, H; Gonçalves, L; Providência, LAINTRODUCTION: Complications at the site of vascular access are the most common adverse events in cardiac catheterization. The use of small gauge catheters may reduce this risk and allow earlier ambulation, the main disadvantage according to some authors being inferior image quality. The aim of our study was to evaluate the safety and image quality of 4 French diagnostic catheters. METHODS: We performed a retrospective study of 1656 patients who underwent diagnostic cardiac catheterization with 4F catheters via the femoral artery between January 2006 and December 2007, and analyzed the complications during and immediately after the procedure. The quality of the films was assessed in 125 consecutive patients from this group, who were also followed up on average one month after hospital discharge. RESULTS: Cardiac catheterization with 4F catheters was technically possible in all cases. Patients were able to ambulate and were discharged from hospital on average four and six hours respectively after the procedure. Complications during or immediately after the procedure occurred in 5.8% of cases. In the subgroup with clinical follow-up, there was minor bleeding at the access site in 16.4% and hematoma in 14.4%; in the latter group, only one patient had major hematoma requiring therapeutic intervention. No other major complications were recorded and the patients resumed their daily activities on average 7 days after discharge. Image analysis revealed that most of the films were of good quality. Conclusion: The use of 4F catheters for diagnostic cardiac catheterization via the femoral approach enables rapid hemostasis and early ambulation, with a low incidence of complications at the access site. This type of catheter provides good quality images and there were no problems in their handling. 4F catheters are therefore a good option to consider for cardiac catheterization, especially when no therapeutic procedures are expected.