Publications by authors named "António Marinho da Silva"

14 Publications

  • Page 1 of 1

Importance of ambulatory blood pressure monitoring in the diagnosis and prognosis of pediatric hypertension.

Rev Port Cardiol 2018 09 2;37(9):783-789. Epub 2018 Jun 2.

Serviço de Cardiologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

The prevalence of high blood pressure (BP) at pediatric age has increased progressively, one of the causes of which is obesity. However, the dominant etiology in this age group is renal and/or cardiovascular pathology. Ambulatory blood pressure monitoring (ABPM) is the method of choice for the diagnosis of hypertension, especially in children at high cardiovascular risk. Its use is limited to children from five years of age. Choosing appropriate cuff size is key to obtaining correct blood pressure. The main indication for ABPM is to confirm the diagnosis of hypertension. It also allows the diagnosis of white coat hypertension (which may represent an intermediate stage between the normotensive phase and hypertension), or masked hypertension, associated with progression to sustained hypertension and left ventricular hypertrophy (LVH). Children with isolated nocturnal hypertension should be considered as having masked hypertension. BP load is defined as the percentage of valid measurements above the 95th percentile for age, gender, and height. Values above 25-30% are pathological and those above 50% are predictive of LVH. ABPM correlates with target organ damage, particularly LVH and renal damage. It is useful in the differentiation of secondary hypertension, since these children show higher BP load and less nocturnal dipping, and confirmation of response to therapy. Thus ABPM allows the diagnosis and classification of hypertension, provides cardiovascular prognostic information and identifies patients with intermediate phenotypes of hypertension.
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http://dx.doi.org/10.1016/j.repc.2017.09.026DOI Listing
September 2018

Congenital Thoracic Venous Anomalies in Adults: Morphologic MR Imaging.

Curr Probl Diagn Radiol 2015 Jul-Aug;44(4):337-45. Epub 2015 Jan 24.

Department of Radiology, Coimbra Hospital and University Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Congenital anomalies of the thoracic veins are rare yet important developmental abnormalities, usually classified into systemic and pulmonary. They may be encountered incidentally; as such the radiologist must be aware of their imaging presentation and clinical relevance. Furthermore, to understand these anomalies, knowledge of the embryological development and of the normal anatomy of the thoracic veins is required. In the age of non-invasive imaging modalities, magnetic resonance is paramount for the characterization of these developmental abnormalities.
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http://dx.doi.org/10.1067/j.cpradiol.2015.01.002DOI Listing
February 2016

Rare cardiac tumor simulating ST elevated acute myocardial infarction.

Int J Cardiol 2014 Nov 4;177(1):e25-8. Epub 2014 Aug 4.

Centro Hospitalar Tondela-Viseu, Serviço de Cardiologia, Portugal.

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http://dx.doi.org/10.1016/j.ijcard.2014.07.168DOI Listing
November 2014

Pulmonary hypertension in Portugal: first data from a nationwide registry.

Biomed Res Int 2013 21;2013:489574. Epub 2013 Oct 21.

Department of Cardiology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000 Coimbra, Portugal ; Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine of University of Coimbra, Azinhaga de Santa Comba, 3000 Coimbra, Portugal.

Introduction: Pulmonary arterial hypertension (PAH) is a rare disease that must be managed in specialized centers; therefore, the availability of epidemiological national data is critical.

Methods: We conducted a prospective, observational, and multicenter registry with a joint collaboration from five centers from Portugal and included adult incident patients with PAH or chronic thromboembolic pulmonary hypertension (CTEPH).

Results: Of the 79 patients enrolled in this study, 46 (58.2%) were classified as PAH and 33 patients (41.8%) as CTEPH. PAH patients had a mean age of 43.4 ± 16.4 years. Idiopathic PAH was the most common etiology (37%). At presentation, PAH patients had elevated right atrial pressure (RAP) (7.7 ± 5.9 mmHg) and mean pulmonary vascular resistance (11.4 ± 6.5 Wood units), with a low cardiac index (2.7 ± 1.1 L·min(-1)·m(-2)); no patient was under selective pulmonary vasodilators; however, at follow-up, most patients were on single (50%), double (28%), or triple (9%) combination vasodilator therapy. One-year survival was 93.5%, similar to CTEPH patients (93.9%), that were older (60.0 ± 12.5 years) and had higher RAP (11.0 ± 5.2 mmHg, P = 0.015).

Conclusions: We describe for the first time nationwide data on the diagnosis, management, and prognosis of PAH and CTEPH patients in Portugal. Clinical presentation and outcomes are comparable with those reported on other national registries.
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http://dx.doi.org/10.1155/2013/489574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818811PMC
June 2014

Long-term effect of bosentan in pulmonary hypertension associated with complex congenital heart disease.

Rev Port Cardiol 2013 Feb 23;32(2):123-9. Epub 2013 Jan 23.

Unidade de Hipertensão Pulmonar, Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Background: Bosentan is recommended for symptomatic patients with Eisenmenger syndrome due to simple congenital lesions such as atrial and ventricular septal defects (VSD). However, its long-term efficacy and safety in patients with pulmonary arterial hypertension (PAH) associated with complex congenital heart disease (CHD) is unknown.

Objectives: We examined the short- and long-term effects and safety profile of bosentan in patients with PAH and complex CHD.

Methods: We followed 14 patients with PAH and complex CHD for a mean of four years. Demographic parameters, exercise capacity assessed by the six-minute walking test (6MWT) and oxygen saturation were assessed at baseline, six months and at follow-up.

Results: Mean age was 37.1 ± 11.7 years; 90% were in WHO class III or IV. The most common diagnosis was pulmonary atresia with VSD (35.7%), followed by truncus arteriosus (28.6%), patent ductus arteriosus (21.4%) and transposition of the great arteries (14.3%). After six months of treatment, six-minute walking distance (6MWD) increased from 371.9 to 428.4 m (p=0.005) and functional class was improved (p=0.005). After four years, one patient discontinued bosentan due to side effects and four patients were started on sildenafil, after a mean 38 months of bosentan treatment. Mean 6MWD for patients on bosentan monotherapy (n=8) was 440.1 ± 103.8 m, whereas for patients on bosentan-sildenafil combination therapy (n=4) it was 428.8 ± 96.9 m, after four years of therapy. Two patients died during follow-up.

Conclusions: Bosentan was safe and was associated with improved exercise capacity in patients with PAH and complex CHD. This improvement was sustained for up to four years and the safety profile was similar to simple CHD patients.
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http://dx.doi.org/10.1016/j.repc.2012.02.023DOI Listing
February 2013

Pulmonary dissection during diagnostic pulmonary angiography.

Rev Port Cardiol 2012 Jun;31(6):465

Serviço de Cardiologia, Hospitals da Universidade de Coimbra - Centro Hospitalar e Universitdrio de Coimbra, Coimbra, Portugal.

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http://dx.doi.org/10.1016/j.repc.2012.04.004DOI Listing
June 2012

Ascending aortic aneurysm and patent foramen ovale: a rare cause of platypnea-orthodeoxia.

Rev Port Cardiol 2011 Apr;30(4):445-50

Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Portugal.

Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea and hypoxia induced by the upright position and relieved by the supine position. Several factors related to atrial anatomy can facilitate shunting through an atrial septal defect; in many cases, the syndrome is associated with patent foramen ovale and right-to-left shunt, and has also been linked to aortic aneurysm. We present a case of platypnea-orthodeoxia syndrome in a 61-year-old woman with patent foramen ovale and ascending aortic aneurysm.
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April 2011

Guidelines for the management of pulmonary hypertension patients.

Rev Port Pneumol 2010 Jul;16 Suppl 4:S7-S85

Grupo de Estudos de Hipertensão Pulmonar da Sociedade Portuguesa de Cardiologia/Pulmonary Hypertension Study Group of the Portuguese Society of Cardiology.

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http://dx.doi.org/10.1016/S0873-2159(15)30103-3DOI Listing
July 2010

[Guidelines for the management of pulmonary hypertension patients].

Rev Port Cardiol 2010 Feb;29(2):253-89

Núcleo de Estudos de Doença Vascular Pulmonar da Sociedade Portuguesa de Medicina Interna, Lisboa, Portugal.

Introduction: Pulmonary hypertension (PH) was until recently an obscure pathology which frequently went unidentified as it lacked a precise diagnostic strategy. Recent years have seen advances in the knowledge of the pathogenesis and mechanisms of vascular lesion of PH. This has led to the scientific community's growing interest in this area, an interest manifested in appreciable progress in the pathology's clinical characterisation, diagnostic strategies and the development of effective drugs. All of this together has been fundamental in changing the previously unfavourable prognosis of this disease. This evolution implies the need to rationalise the use of available resources through organisation of healthcare services, defining the role of each level of care, and developing norms for good clinical management practices in keeping with best medical practice guidelines. These twin aspects have attracted the interest of the scientific community, as shown by the wealth of literature, and have led healthcare authorities to introduce regulatory mechanisms. In order to improve clinical practice, the Pulmonary Vascular Disease Study Group (NEDVP) of the Portuguese Society of Internal Medicine (SPMI), the Pulmonary Hypertension Study Group (GEHTP) of the Portuguese Society of Cardiology and the boards of the Portuguese Societies of Pulmonology and Paediatric Cardiology created an interdisciplinary working group. The group's remit was to draft this document, "Guidelines for the management of pulmonary hypertension patients", based on a review of the literature and the authors' clinical expertise. These guidelines aim to present all the relevant evidence on the diagnostic and treatment strategy of PH and the definition of requirements for referral centres. The organisation of care is fundamental for an appropriate and rational use of the available resources and for the better care of the patient.
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February 2010

Patent ductus arteriosus--neonatal intensive care unit registry.

Rev Port Cardiol 2008 Jul-Aug;27(7-8):877-85

Serviço de Neonatologia e Unidade de Cardiologia Pediátrica dos Hospitals da Universidade de Coimbra, Coimbra, Portugal.

Objectives: This study took place at the Neonatal Intensive Care Unit (NICU) of the Dr Daniel de Matos Maternity Hospital and evaluated the incidence of patent ductus arteriosus (PDA), the clinical evolution of the newborns affected, the treatment prescribed, and associated morbidity and mortality.

Methods: We carried out a retrospective medical chart review of newborns admitted to the NICU between January 2001 and December 2005.

Results: PDA was found in 69 newborns. Median gestational age (GA) was 28 weeks and birth weight (BW) 1100 grams. The diagnosis of PDA was established, on average, between the fifth and sixth day of life. Of the 53 newborns with criteria for closure, 49 had indomethacin therapy, with a success rate of 88%; surgical ligation was subsequently necessary in six of these. Thirty-eight newborns presented associated comorbidities, and eight died.

Conclusions: The results obtained in this study are in agreement with the literature. In cases with GA of less than 30 weeks and/or BW below 1500g, the need for treatment for PDA closure is greater than in cases with higher GA/BW, and a more aggressive approach is required, with presymptomatic prolonged indomethacin. The results obtained in this work led us to conclude that echocardiography should be performed to screen for PDA in all newborns of less than 30 weeks or with BW below 1500g. We intend in the near future to answer a question that emerged from this study: will earlier diagnosis lead to improved outcomes?
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March 2009

Percutaneous retrieval of foreign bodies from the cardiovascular system.

Rev Port Cardiol 2007 Jul-Aug;26(7-8):755-8

Unidade de Cardiologia Pediátrica e Serviço de Imagiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal.

We report our experience of seven patients referred to our hospital with foreign bodies embolized in the cardiovascular system, namely fragmented catheters and devices used in interventional techniques, which were retrieved by a percutaneous approach. The patients' ages ranged from 2 to 29 years, with a mean age of 17. The majority (57%) were male. The retrieval equipment used included a pigtail catheter, multipurpose catheter with hand-prepared snare, Amplatz gooseneck snare, nitinol multisnare set and basket catheter. The foreign bodies were successfully removed percutaneously in all cases, with no complications.
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February 2008

Ectopic origin of the right coronary artery--case report.

Rev Port Cardiol 2007 May;26(5):569-73

Unidade de Cardiologia Pediátrica do Serviço de Cardiologia e Departamento de Cirurgia Cardiotorácica dos Hospitais da Universidade de Coimbra, Coimbra, Portugal.

Coronary artery anomalies can occur in isolation or in association with other congenital heart defects. Clinical presentation ranges from asymptomatic forms to sudden cardiac death. The authors report a case of anomalous origin of the right coronary artery from the left sinus of Valsalva, diagnosed with multidetector computed tomography coronary angiography.
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May 2007

Cardiac tumors in the pediatric age group--case reports.

Rev Port Cardiol 2005 Dec;24(12):1509-15

Unidade de Cardiologia Pediátrica, Serviço de Cardiologia e Centro de Cirurgia Cardiotorácica, Hospitais da Universidade de Coimbra, Coimbra, Portugal.

We present two case reports of primary cardiac tumors diagnosed in the pediatric age group, with different clinical evolution and therapeutic approach.
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December 2005

Arterial duct occlusion by thrombosis: clinical case.

Rev Port Cardiol 2003 Jul-Aug;22(7-8):977-9

Unidade de Cardiologia Pediátrica, Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Coimbra.

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December 2003