Disciplina Discipline IDP5003
Tratamento Intervencionista das Doenças Estruturais do Coração

Treatment Interventions in Structural Heart Diseases

Área de Concentração: 98132

Concentration area: 98132

Criação: 17/01/2022

Creation: 17/01/2022

Ativação: 06/04/2022

Activation: 06/04/2022

Nr. de Créditos: 5

Credits: 5

Carga Horária:

Workload:

Teórica

(por semana)

Theory

(weekly)

Prática

(por semana)

Practice

(weekly)

Estudos

(por semana)

Study

(weekly)

Duração Duration Total Total
5 8 12 3 semanas 3 weeks 75 horas 75 hours

Docentes Responsáveis:

Professors:

Simone Rolim Fernandes Fontes Pedra

Dimytri Alexandre de Alvim Siqueira

Objetivos:

Introduzir um panorama do desenvolvimento e estado atual das principais técnicas terapêuticas intervencionistas e minimamente invasivas para correção das doenças estruturais do coração. Apresentar e discutir os resultados e aplicação clínica dos procedimentos. Rever as indicações, a seleção e a avaliação anatômica das doenças estruturais passíveis de tratamento percutâneo e híbrido.

Objectives:

Introduce an overview of the development and status of the main interventional and minimally invasive therapeutic techniques for the treatment of structural heart diseases. Present and discuss the results and clinical application of the procedures. Review the indications, selection and anatomical evaluation of structural diseases that can be treated percutaneously and in a hybrid fashion.

Justificativa:

As doenças estruturais do coração, congênitas ou adquiridas, representam grande parte das cardiopatias na população pediátrica, adulta e idosa. Com o aumento da expectativa de vida da população brasileira a prevalência das cardiopatias vem aumentando nos idosos e a necessidade de técnicas menos invasivas tem sido largamente implantada. Os resultados obtidos pelas diferentes técnicas demonstram que as terapêuticas intervencionistas e híbridas são aplicadas cada vez mais em doenças estruturais. O desenvolvimento tecnológico na área médica permitiu a introdução de novos dispositivos para o tratamento de doenças que eram abordadas exclusivamente de forma cirúrgica convencional. O Instituto Dante Pazzanese de Cardiologia é pioneiro na introdução das diferentes técnicas transcateter, híbridas e minimamente invasivas.

Rationale:

Congenital or acquired structural heart diseases represent a large part of heart diseases in the pediatric, adult, and elderly population. With the increase in life expectancy of the Brazilian population, the prevalence of heart diseases has been increasing in the elderly and the need for less invasive techniques has been widely implemented. The results obtained by the different techniques show that interventional and hybrid therapies are increasingly applied in structural diseases. The technological development in the medical field allowed the introduction of new devices for the treatment of diseases that were addressed exclusively in a conventional surgical way. Dante Pazzanese Institute of Cardiology is a pioneer in the introduction of different transcatheter, hybrid and minimally invasive techniques.

Conteúdo:

• Aulas ministradas em Módulos divididos em temas: Cardiopatias Congênitas, Valvopatias e Procedimentos Híbridos. • Seminários dos temas apresentados no último dia do curso. MÓDULO I- CARDIOPATIAS CONGENITAS 1. Aplicação das valvoplastias 2. Emprego de “stents” nas Cardiopatias Congênitas 3. Oclusão de defeitos septais. 4. Papel da ecocardiografia no tratamento percutâneo das cardiopatias congênitas 5. Intervenções percutâneas no período neonatal 6. Procedimentos híbridos nas cardiopatias congênitas 7. Implante percutâneo de valvas 8. Intervenções Cardíacas na Vida Fetal MÓDULO II- CARDIOPATIAS ESTRUTURAIS 1. Indicação de intervenção na valvopatia mitral 2. Resultados dos principais estudos na intervenção percutânea da estenose mitral 3. Resultados dos principais estudos na intervenção percutânea da insuficiência mitral 4. Tipos de próteses valvares disponíveis 5. Indicação de intervenção na valvopatia aórtica 6. Resultados dos principais estudos na intervenção percutânea da estenose aórtica 7. Seleção dos pacientes para implante da prótese transcateter 8. Quando indicar oclusão de vazamento paraprotético, e quais as opções possíveis para oclusão 9. Oclusão percutânea do apêndice atrial esquerdo. Indicações e resultados Seminários: Módulo I Módulo II

Content:

• Classes taught in Modules divided into two topics: congenital heart diseases and Valvopathies • Seminars presented on the last day of the course. MODULE I- CONGENITAL HEART DISEASES 1. Application of valvuloplasties 2. Use of stents in congenital heart diseases 3. Occlusion of septal defects. 4. Role of echocardiography in the percutaneous treatment of congenital heart diseases 5. Percutaneous interventions in the neonatal period 6. Hybrious procedures in congenital heart diseases 7. Percutaneous valve implantation 8. Cardiac Interventions in Fetal Life MODULE II - STRUCTURAL HEART DISEASES 1. Indication of intervention in mitral valve disease 2. Results of major studies in percutaneous mitral intervention 3. Results of major studies in the percutaneous intervention of mitral insufficiency 4. Types of valve prostheses available 5. Indication of intervention in aortic valve disease 6. Results of major studies in percutaneous intervention of aortic stenosis 7. Selection of patients for transcatheter valves implantation 8. Paraprosthetic leak occlusion and possible device options for occlusion Seminars: Module I Module II

Forma de Avaliação:

Seminário apresentado. Notas finais: conceitos A, B, C ou R

Type of Assessment:

Seminar presented. Final score: grades A, B, C or R

Bibliografia:

1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD, 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease, Journal of the American College of Cardiology, (2014), doi: 10.1016/j.jacc.2014.02.536. 2. Guideline for the Management of Patients with Valvular Heart Disease. European Heart Journal (2012) 33, 2451–2496 3. Tarasoutchi F, Montera MW, Grinberg M, Barbosa MR, Piñeiro DJ, Sánchez CRM, et al. Diretriz Brasileira de Valvopatias - SBC 2011 / I Diretriz Interamericana de Valvopatias - SIAC 2011. Arq Bras Cardiol, 2011; 97(5 supl. 3): 1-67 4. Leon MB, Smith CR, Mack M, et al.Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363:1597-607. 5. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187-98. 6. Stratification of Outcomes After Transcatheter Aortic Valve Replacement According to Surgical Inoperability for Technical Versus Clinical Reasons J Am Coll Cardiol 2014;63:901–11 7. O’Gara et al, Transcatheter Therapies for Mitral Regurgitation Societal Overview, JACC Vol. 63, No. 8, 2014:840–52 7. Bouleti C, Iung B, Laoue´nan C, Himbert D, Brochet E, Messika-Zeitoun D, De´taint D, Garbarz E, Cormier B, Michel PL, Mentre´ F, Vahanian A. Late results of percutaneous mitral commissurotomy up to 20 years. Development and validation of a risk score predicting late functional results from a series of 912 patients. Circulation 2012;125:2119–2127. 8. Percutaneous Transcatheter Mitral Valve Replacement: An Overview of Devices in Preclinical and Early Clinical Evaluation. Circ Cardiovasc Interv. 2014;7:400-409, originally published June 17, 2014. 9. Guerrero M, Greenbaum A, O'Neill W. First in human percutaneous implantation of a balloon expandable transcatheter heart valve in a severely stenosed native mitral valve. Catheter Cardiovasc Interv. 2014 Jun 1;83(7):E287-91. doi: 10.1002/ccd.25441. Epub 2014 Mar 14. 10. Ferrari E, Niclauss L, Locca D, Marcucci C. On-pump fibrillating heart mitral valve replacement with the SAPIENTM XT transcatheter heart valve. Eur J Cardiothorac Surg. 2014 Apr;45(4):749-51. doi: 10.1093/ejcts/ezt364. Epub 2013 Jul 11. 11. Himbert D, Bouleti C, Iung B, Nejjari M, Brochet E, Depoix JP, Ghodbane W, Fassa AA, Nataf P, Vahanian A. Transcatheter valve replacement in patients with severe mitral valve disease and annular calcification. J Am Coll Cardiol. 2014 Dec 16;64(23):2557-8. doi: 10.1016/j.jacc.2014.09.047. 12. Holzer RJ, Hijazi ZM. Transcatheter pulmonary valve replacement: State of the art. Catheter Cardiovasc Interv. 2015 Oct 1. doi: 0.1002/ccd.26263. 13. Bentham JR, Thomson JD. Current state of interventional cardiology in congenital heart disease. Arch Dis Child. 2015 Aug;100(8):787-92. 14. Moon-Grady AJ, Morris SA, Belfort M, Chmait R, Dangel J, Devlieger R, Emery S, Frommelt M, Galindo A, Gelehrter S, Gembruch U, Grinenco S, Habli M, Herberg U, Jaeggi E, Kilby M, Kontopoulos E, Marantz P, Miller O, Otaño L, Pedra C, Pedra S, Pruetz J, Quintero R, Ryan G, Sharland G, Simpson J, Vlastos E, Tworetzky W, Wilkins-Haug L, Oepkes D. International Fetal Cardiac Intervention Registry: A Worldwide Collaborative Description and Preliminary Outcomes. J Am Coll Cardiol. 2015 Jul 28;66(4):388-99 15. Meadows J, Minahan M, McElhinney DB, McEnaney K, Ringel R; COAST Investigators*. Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST). Circulation. 2015 May 12;131(19):1656-64 16. Borik S1, Crean A1, Horlick E1, Osten M1, Lee KJ1, Chaturvedi R1, Friedberg MK1, McCrindle BW1, Manlhiot C1, Benson L2. Percutaneous pulmonary valve implantation: 5 years of follow-up: does age influence outcomes? Circ Cardiovasc Interv. 2015 Feb;8(2):e001745. 17. Schranz D, Michel-Behnke I. Advances in interventional and hybrid therapy in neonatal congenital heart disease. Semin Fetal Neonatal Med. 2013 Oct;18(5):311-21. 18. Holoshitz N, Kenny D, Hijazi ZM. Hybrid interventional procedures in congenital heart disease. Methodist Debakey Cardiovasc J. 2014 Apr-Jun;10(2):93-8. 19. Kalfa D, Torres AJ. Indications and results for hybrid interventions in patients with congenital heart disease. Arch Cardiovasc Dis. 2020 Feb;113(2):96-103. 20. Price MJ. Left Atrial Appendage Occlusion: Data Update. Interv Cardiol Clin. 2018 Apr;7(2):159-168. doi: 10.1016/j.iccl.2017.12.002. 21. Vainrib AF, Harb SC, Jaber W, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Left Atrial Appendage Occlusion/Exclusion: Procedural Image Guidance with Transesophageal Echocardiography.J Am Soc Echocardiogr. 2018 Apr;31(4):454-474. 22. Mohammed M, Ranka S, Reddy M. Percutaneous left atrial appendage occlusion. Curr Opin Cardiol. 2021 Jan;36(1):36-43. 23. Mandrola JM, Foy AJ.Left atrial appendage occlusion: a critical appraisal updated with recent evidence. Curr Opin Cardiol. 2020 Jan;35(1):30-34.

Bibliography:

1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD, 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease, Journal of the American College of Cardiology, (2014), doi: 10.1016/j.jacc.2014.02.536. 2. Guideline for the Management of Patients with Valvular Heart Disease. European Heart Journal (2012) 33, 2451–2496 3. Tarasoutchi F, Montera MW, Grinberg M, Barbosa MR, Piñeiro DJ, Sánchez CRM, et al. Diretriz Brasileira de Valvopatias - SBC 2011 / I Diretriz Interamericana de Valvopatias - SIAC 2011. Arq Bras Cardiol, 2011; 97(5 supl. 3): 1-67 4. Leon MB, Smith CR, Mack M, et al.Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363:1597-607. 5. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187-98. 6. Stratification of Outcomes After Transcatheter Aortic Valve Replacement According to Surgical Inoperability for Technical Versus Clinical Reasons J Am Coll Cardiol 2014;63:901–11 7. O’Gara et al, Transcatheter Therapies for Mitral Regurgitation Societal Overview, JACC Vol. 63, No. 8, 2014:840–52 7. Bouleti C, Iung B, Laoue´nan C, Himbert D, Brochet E, Messika-Zeitoun D, De´taint D, Garbarz E, Cormier B, Michel PL, Mentre´ F, Vahanian A. Late results of percutaneous mitral commissurotomy up to 20 years. Development and validation of a risk score predicting late functional results from a series of 912 patients. Circulation 2012;125:2119–2127. 8. Percutaneous Transcatheter Mitral Valve Replacement: An Overview of Devices in Preclinical and Early Clinical Evaluation. Circ Cardiovasc Interv. 2014;7:400-409, originally published June 17, 2014. 9. Guerrero M, Greenbaum A, O'Neill W. First in human percutaneous implantation of a balloon expandable transcatheter heart valve in a severely stenosed native mitral valve. Catheter Cardiovasc Interv. 2014 Jun 1;83(7):E287-91. doi: 10.1002/ccd.25441. Epub 2014 Mar 14. 10. Ferrari E, Niclauss L, Locca D, Marcucci C. On-pump fibrillating heart mitral valve replacement with the SAPIENTM XT transcatheter heart valve. Eur J Cardiothorac Surg. 2014 Apr;45(4):749-51. doi: 10.1093/ejcts/ezt364. Epub 2013 Jul 11. 11. Himbert D, Bouleti C, Iung B, Nejjari M, Brochet E, Depoix JP, Ghodbane W, Fassa AA, Nataf P, Vahanian A. Transcatheter valve replacement in patients with severe mitral valve disease and annular calcification. J Am Coll Cardiol. 2014 Dec 16;64(23):2557-8. doi: 10.1016/j.jacc.2014.09.047. 12. Holzer RJ, Hijazi ZM. Transcatheter pulmonary valve replacement: State of the art. Catheter Cardiovasc Interv. 2015 Oct 1. doi: 0.1002/ccd.26263. 13. Bentham JR, Thomson JD. Current state of interventional cardiology in congenital heart disease. Arch Dis Child. 2015 Aug;100(8):787-92. 14. Moon-Grady AJ, Morris SA, Belfort M, Chmait R, Dangel J, Devlieger R, Emery S, Frommelt M, Galindo A, Gelehrter S, Gembruch U, Grinenco S, Habli M, Herberg U, Jaeggi E, Kilby M, Kontopoulos E, Marantz P, Miller O, Otaño L, Pedra C, Pedra S, Pruetz J, Quintero R, Ryan G, Sharland G, Simpson J, Vlastos E, Tworetzky W, Wilkins-Haug L, Oepkes D. International Fetal Cardiac Intervention Registry: A Worldwide Collaborative Description and Preliminary Outcomes. J Am Coll Cardiol. 2015 Jul 28;66(4):388-99 15. Meadows J, Minahan M, McElhinney DB, McEnaney K, Ringel R; COAST Investigators*. Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST). Circulation. 2015 May 12;131(19):1656-64 16. Borik S1, Crean A1, Horlick E1, Osten M1, Lee KJ1, Chaturvedi R1, Friedberg MK1, McCrindle BW1, Manlhiot C1, Benson L2. Percutaneous pulmonary valve implantation: 5 years of follow-up: does age influence outcomes? Circ Cardiovasc Interv. 2015 Feb;8(2):e001745. 17. Schranz D, Michel-Behnke I. Advances in interventional and hybrid therapy in neonatal congenital heart disease. Semin Fetal Neonatal Med. 2013 Oct;18(5):311-21. 18. Holoshitz N, Kenny D, Hijazi ZM. Hybrid interventional procedures in congenital heart disease. Methodist Debakey Cardiovasc J. 2014 Apr-Jun;10(2):93-8. 19. Kalfa D, Torres AJ. Indications and results for hybrid interventions in patients with congenital heart disease. Arch Cardiovasc Dis. 2020 Feb;113(2):96-103. 20. Price MJ. Left Atrial Appendage Occlusion: Data Update. Interv Cardiol Clin. 2018 Apr;7(2):159-168. doi: 10.1016/j.iccl.2017.12.002. 21. Vainrib AF, Harb SC, Jaber W, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Left Atrial Appendage Occlusion/Exclusion: Procedural Image Guidance with Transesophageal Echocardiography.J Am Soc Echocardiogr. 2018 Apr;31(4):454-474. 22. Mohammed M, Ranka S, Reddy M. Percutaneous left atrial appendage occlusion. Curr Opin Cardiol. 2021 Jan;36(1):36-43. 23. Mandrola JM, Foy AJ.Left atrial appendage occlusion: a critical appraisal updated with recent evidence. Curr Opin Cardiol. 2020 Jan;35(1):30-34.

Idiomas ministrados:

Português

Languages taught:

Portuguese

Tipo de oferecimento da disciplina:

Presencial

Class type:

Presencial