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J Queiroz e Melo

Publications and source records attributed to J Queiroz e Melo.

12 recordsLinked to original sources
PubMed2001

[Morbidity and mortality after heart transplanation].

AIM: To evaluate the morbidity and mortality after heart transplantation in the patients treated at Santa Cruz Hospital. METHODS: Between February 1986 and December 2000, 113 patients underwent orthotopic heart transplantation at Santa Cruz Hospital. Actuarial survival rates at 12 months, 5 and 10 years after surgery were calculated (Kaplan-Meier analysis). We identified the causes of death and evaluated their relation with time after transplantation. Quality of life after surgery was assessed by functional status and employment status. Main causes of morbidity were identified: infection, rejection, tumors, allograft vasculopathy and side effects of chronic immunosuppression. RESULTS: Eighty-one patients (71.7%) were discharged alive after transplantation. In this group, actuarial survival was 82.2% at 12 months, 64.6% at 5 years and 45.3% at 10 years. Maximal survival was 14.7 years. In the immediate postoperative period, the main causes of mortality were procedure-related ou primary cardiac complications. Infection was the most common cause of death in the first 3 months after transplantation. Allograft vasculopathy was the main cause of death in the group of patients surviving the first year. Malignancy was another cause of late mortality. Clinically relevant non-fatal infections occurred in 35.4% of our patients. Overall, 108 mild rejection episodes were diagnosed in 55 patients, 82 moderate rejection episodes in 52 patients and 9 severe rejections in 8 patients. Eleven non-fatal tumors were detected in 10 patients. In the group of patients who have underwent at least one coronary arteriography, 34.6% present allograft vasculopathy. Clinically relevant complications of chronic immunosuppression were: hypertension in 50% patients; dyslipidemia in 31%; osteoporosis in 19.5%; diabetes mellitus in 15%; end-stage renal failure in 3.5%. CONCLUSION: Cardiac transplantation is a valid treatment for end-stage heart failure. Most patients surviving long-term are in good physical status and their quality of life is comparable to that of the general population.

Adolescent↗
PubMed1997

[Angina pectoris: the possibilities for surgical treatment. Recent progress].

After reviewing the history of coronary surgery the author describes the different grafts used in coronary artery bypass grafting and its results. They vary with coronary anatomy, left ventricle function, age, arterial hypertension, diabetes, etc. The rationale of the different surgical approaches are discussed, emphasizing the advantages of a close medical-surgical cooperation.

Angina Pectoris↗
PubMed1996

[Clinical and echocardiographic assessment of surgical replacement of the aortic valve with lung autograft: results after 2 years].

OBJECTIVE: The goal of this study was to evaluate the clinical and echocardiographic results of a cohort of patients subjected to aortic valve replacement with pulmonary autograft (Ross procedure). DESIGN: We studied prospectively with clinical and echocardiographic evaluation all patients subjected to this type of aortic valve surgery, before operation, intraoperatively, before hospital discharge and at the end of this study in September 1994 and we analysed the evolution of the results during the follow-up period. PATIENTS: 22 consecutive patients 12 men and 10 women mean age 48 +/- 14 years subjected to Ross operation between April 1992 and June 1994. METHODS: Patients were studied with transesophageal echocardiography intraoperatively and transthoracic echocardiography. Two-dimensional and M-mode evaluation, continuous and pulsed wave Doppler and color coded Doppler were performed, with assessment of the morphology and Doppler profile of both the autograft and the homograft in pulmonary position. RESULTS: No early or late mortality was registered, and apart two patients who were reoperated, all patients were asymptomatic in the last medical visit. There was no incidence of thromboembolic events even though no anticoagulation has been used. Aortic regurgitation was present in 14 patients, grade 1 in 11 patients and grade 2 in three. In the last echocardiogram performed the analysis of aortic flow, demonstrated absence of significant transvalvular gradient (maximal aortic gradient of 5.6 +/- 0.4 mmHg and mean aortic gradient of 1.8 +/- 0.08 mmHg). Pulmonary regurgitation was absent in nine patients, and present in 13, considered trivial in all cases. CONCLUSIONS: These data suggest that this type of surgery has a low operative risk, with absence of thromboembolic complications and excellent clinical and echocardiographic results.

Adolescent↗
PubMed1993

Peptidergic innervation of human epicardial coronary arteries.

The peptidergic innervation of proximal (internal diameter, > 0.8 mm) and distal (internal diameter, < 0.8 mm) regions of human epicardial coronary arteries was investigated by means of immunohistochemical, chromatographic, radioimmunological, and in vitro pharmacological techniques. The use of an antiserum to the general neuronal marker protein gene product 9.5 revealed that the proximal part of epicardial arteries possessed a relatively sparse supply of nerve fibers forming a loose network in the adventitia. The perivascular network increased in density as the vessels were followed distally. In both proximal and distal regions, the majority of nerve fibers possessed neuropeptide Y and tyrosine hydroxylase immunoreactivity. Calcitonin gene-related peptide (CGRP)- and substance P-immunoreactive nerve fibers were very sparse in the proximal region of the arteries and increased in number distally. Only a few scattered vasoactive intestinal peptide (VIP)-immunoreactive nerve fibers were detected in both arterial regions. The use of high-performance liquid chromatography and radioimmunoassay revealed that the immunoreactive material present in coronary artery extracts closely resembled synthetic peptides. An in vitro pharmacological method demonstrated that neuropeptide Y elicited no detectable response in either proximal or distal arterial segments. In contrast, CGRP, substance P, and VIP all produced a concentration-dependent relaxation of both arterial regions. CGRP and substance P were stronger and more potent than VIP. CGRP and substance P induced a more potent response in distal compared with proximal regions of the arteries. These results suggest that the peptidergic nerves supplying human large epicardial coronary arteries may be predominantly involved in mediating vasodilation.

Adult↗
PubMed1990

[Effects of coronary surgery on silent ischemia].

In order to assess the effects of coronary artery bypass surgery on silent myocardial ischemia, we studied a group of 39 consecutive patients, 38 male and 1 female with a mean age of 56 + 7 years, with stable chronic angina pectoris, by 48 hours-Holter monitoring and maximal treadmill exercise test before and after operation. The reduction of angina was 92% (p less than 0.0001) and of ischemia 57% (p less than 0.0001) after operation. Silent myocardial ischemia was detected in 21 patients (54%) before operation, 13 by Holter, 4 by exercise test and 4 by the two methods. After operation 13 patients (36%) continue to have silent ischemia depicted in 7 by Holter and in 7 by exercise test. No new patient developed silent ischemia after operation. The group of patients with silent ischemia preoperatively was not significantly different from the group without silent ischemia based on clinical and angiographic characteristics, results of surgery and exercise test parameters with exception of ST segment depression. In conclusion, silent myocardial ischemia may persist after successful coronary artery bypass surgery for the relief of angina pectoris, and should be monitored by serial Holter recordings and treated medically, if its prognosis and consequences proved to be similar to manifest symptomatic ischemia.

Adult↗
PubMed1989

[Heart transplant].

The author presents a short historical note on the evolution of heart transplantation. He comments on the problems related with patient selection, organ donation and harvesting, and clinical evolution after transplantation, based on his experience with 21 patients submitted to heart transplantation. They are divided in two groups. The first, includes 4 who were operated on while being on heart assisted devices and had a hospital mortality of 50% (14-86; CL 70%). The second comprises the other 17 patients who had a hospital mortality of 12% (14-86; CL 70%). On a average hospital stay of 45 days, 59% of the patients had complications, on a average of 2.4 events per patient. Infectious problems were the most frequent. He emphasis the need for a earlier surgical indication to prevent the height incidence of post operative complications. There were 1.6 rejection episodes per patient on an average follow up period of 11 months. Actuarial survival curve shows a 67% survival at 2 years.

Adolescent↗