S1409-414220000003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000300002 Los antagonistas de la angiotensina y la morbimortalidad cardiovascular: ¿mito o realidad? Martínez Felipe ,Universidad Nacional de Córdoba Facultad de Medicina Córdoba Argentina 12 2000 2000 2 3 3
S1409-414220000003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000300003 Utilidad del análisis de la variabilidad de la frecuencia cardíaca en la valoración de neuropatía autonómica diabética Gutiérrez Oswaldo Putvinsky Alexei Padilla Juan I Ramírez Catalina Mora Carlos ,Universidad de Iberoamérica Cátedra de Fsiología ,Universidad de Iberoamérica Cátedra de Medicina San José Costa Rica 12 2000 2000 2 4 12

Introducción. Una complicación de la Diabetes Mellitus es la neuropatía autonómica diabética (NAD), la cual tradicionalmente se diagnostica con criterios clínicos. El análisis de la variabilidad de la frecuencia cardíaca (VFC), consiste en el estudio de las variaciones de tiempo entre latido y latido consecutivos del corazón, reflejo de la influencia y que tiene importancia pronóstica. Objetivo. Determinar la utilidad del análisis de la VFC como método auxiliar para el diagnóstico y clasificación de los pacientes con NAD. Material y métodos. Se eligieron individuos con diagnóstico clínico de diabetes mellitus tipo 2 con NAD y como grupo control, diabéticos sin NAD; también se incluyó un grupo control de individuos sanos. Para el registro, se empleó un equipo PowerLab utilizando una derivación electrocardiográfica durante 5 minutos. Se estimaron variables en dominio de tiempo y de frecuencia y se compararon entre los grupos. Resultados. Se estudiaron 6 pacientes diabéticos con NAD, 3 sin NAD y 6 sujetos sanos. La diferencia más dramática se observó en el grupo de pacientes diabéticos con NAD. Al compararse valores promedio entre ambos grupos de diabéticos se observaron diferencias significativas tanto en variables de dominio de tiempo como de frecuencia: SDNN 26.799 vs 12.601, p=0.047, SDdNN 21.880 vs 9.953, p=0.031, RMSSD 21.841 vs 9.940, p=0.03), LF 125.937 vs 35.077, p=0.1 y HF 67.717 vs 14.472, p=0.02). No se encontró diferencias entre diabéticos sin NAD y controles sanos. Conclusión. El análisis de la VFC es útil en la valoración cuantitativa de la NAD, lo cual tiene importancia pronóstica.

Introduction. A recognized diabetes mellitus complication is autonomic neuropathy (DAN), that is usually diagnosed by clinical criteria. Heart rate variability analysis (HRV) consist in the study of time variations along consecutive heart beats, reflecting autonomic influence, with prognostic importance. Objetive. To determine usefullness of HRV analysis as ancilliary method for diagnosis and follow-up of patients with DAN. Materials y methods. We selected type 2 diabetic patients with clinical diagnosis of DAN and without DAN, as control group. Also we included healthy individuals. For data adquisition we used a PowerLab equipment with a single electrocardiographic lead, during 5 minutes. We calculate time domain and frequency domain variables and compared it between groups. Results. We studied 6 diabetic patients witn DAN, 3 without DAN and 6 normal subjects. The most dramatic difference ocurred in diabetics with DAN. Comparing mean values between both groups of diabetics we observed statistical differences in time domain and in frequency domain variables: SDNN 26.799 vs 12.601, p=0.047, SDdNN 21.880 vs 9.953, p=0.031, RMSSD 21.841 vs 9.940, p=0.03), LF 125.937 vs 35.077, p=0.1 and HF 67.717 vs 14.472, p=0.02). We did not found differences between diabetes without DAN and normal controls. Conclusion. HRV analysis is usefull in evaluating cuantitatively DAN, with prognosis information.

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S1409-414220000003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000300004 Tratamiento de la persistencia del conducto arterioso con el coil desprendible de gianturco Gutiérrez Rafael Castro Abdón Berrios Nubia Mas Carlos ,CCSS Hospital Nacional de Niños San José Costa Rica ,Hospital de León Nicaragua 12 2000 2000 2 13 17

Se encontraron 43 pacientes con persistencia del conducto arterioso en un período de 26 meses. Dos pacientes tenían además una estenosis pulmonar valvular y tres pacientes defectos septales (dos comunicaciones interventriculares y un canal AV). Se observaron tres casos con migración del coil a la pulmonar, de los cuales se logró extraer dos. El tamaño del coil más usado es el de 5 mm y cinco vueltas y el siguiente es el de 8 mm y cinco vueltas. Cuatro pacientes ameritaron dos coils para cerrar el conducto arterioso. En siete pacientes se encontró hipertensión arterial pulmonar de leve a moderada de los cuales cinco eran síndrome de Down. El diámetro del ductus más frecuentemente observado fue el de 2 mm. con una variación de 1,7 a 4 mm. La edad al momento del cierre varió de 6 meses a 10 años con una media de 42,9 meses +-26,3 meses; el peso varió de 7 a 30 kilos con una media de 14,9 kilos+-5,5 kilos.

We found 43 patients with patent ductus arteriosus in a period of 26 months. Two patients had a pulmonary valve stenosis and three patients show septum defects( ventricular septal defect in two and one with an AV canal). We have three patients with migration of the coil to the pulmonary artery without consequences. The size of the coil more frequently used was 5 mm and 5 loops. Four patient need two coils for closure of the PDA. Seven patients show pulmonary hypertension from mild to moderate, five of them were Down syndrome. The diameter of the ductus more frequently observed was 2 mm. The age at the moment of the closure was 6 months to 10 years mean 42,9 months+-26,3 months; the weight was from 7 kilos to 30 kilos mean 14,9+-5,5 kilos.

 ductus arteriosus ductus arteriosus coil Rao PS Balfour IC Jureidini SB Singh GK Chen SC Five loop coil occlusion of patent ductus arteriosus presents recurrence of shunt at follow up Catheter Cardiovasc Interv 2000 50 ^s2 Hofbeck M Bartolomaeus G Buheitel G Esser R Gravinghoff L Hoffman W Kienart W Michel-Behnke I Scharabrine EG Schranz D Schmatty AA Shaklov BE Singer H Lindenger A Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre study Europ J Pediatr 2000 159 ^s5 Le Blanc JG Russell JL Sett SR Potts JE Human DG Culham JA The evolution of ductus arteriosus treatment Int Surg 2000 85 ^s1 Sanatani S Potts JE Ryan A Sandor GC Human DG Culdham JA Coil occlusion of the patent ductus arteriosus: lessons learned Cardiovasc Intervent Radiol 2000 23 ^s2 Hiyazi A Mazhar R Bricely V Robida A Embolization of Gianturco coil into the pulmonary artery requiring emergency surgical intervention Tex Heart Inst J 1999 26 ^s4 Lee LC Hsieh K Huang T Choong C Spontaneous resolution of hemolysis after partial coil occlusion of ductus arteriosus Pediatr Cardiol 1999 20 ^s5 Goyal VS Fulwani MC Ramakantan R Kulkarni HL Dalvi BV Follow up after coil closure of patent ductus arteriosus Am J Cardiol 1999 83 ^s3 Prieto LR De Camillo DM Konrad DJ Scalet-Longworth L Latson LA Comparison of cost and clinical outcome between transcatheter coil occlusion and surgical closure of isolated patent ductus arteriosus Pediatrics 1998 101 ^s6 Vzum O Dickinson D Parsons J Gibbs JL Residual and recurrent shunts after implantations of Cook detachable duct occlusion coils Heart 1998 79 ^s3 Pedra CA Pedra SR Esteres CA Braga SL Fontes VF Simultaneous treatment of pulmonary valve stenosis and patent ductus arteriosus by interventional catheterization Arq Bras Cardiol 1997 68 ^s5 Porstamn W Wierny L Warnke H Catheter closure of patent ductus arteriosus: 62 cases treated without toracotomy Radiol Clin North Am 1971 9 Janorkar S Goh T Wilkinson J Transcatheter closure of patent ductus arteriosus with the use of Rashkind occluders and/or Gianturco coils: lomg term follow-up in 123 patients and special reference to comp[arison, residual shunts, complications, and technique Am Heart J 1999 138 ^s6
S1409-414220000003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000300005 Angioplastía primaria en el manejo del infarto agudo al miocardio, experiencia inical en Panamá Rodríguez Antonio Calzada Norberto Nuñez Percy Pichel Daniel Motta Jorge Arrocha Alberto ,Hospital Nacional Centro Médico Paitilla Ciudad de Panamá Panamá 12 2000 2000 2 19 28

En los últimos años se han redoblado los esfuerzos para disminuir y en el mejor de los casos evitar el daño al músculo cardíaco durante el infarto agudo. Las drogas trombolíticas han contribuido positivamente al respecto. Sin embargo, nace la necesidad de buscar formas alternas de tratamiento que proporcionen un más rápido y efectivo restablecimiento de la circulación coronaria. Nos referimos a la Angioplastía Primaria como tratamiento inicial del infarto agudo. Presentamos los primeros 16 casos con infarto agudo al miocardio en curso, tratados con Angioplastía Primaria, 15 de 16 pacientes evolucionaron en forma satisfactoria, sin complicaciones intra-hospitalarias. Hubo una defunción más directamente relacionada a las complicaciones del infarto que al procedimiento de angioplastía per-se. De esta manera reafirmamos la utilidad de esta nueva forma de tratamiento, planteando una alternativa terapéutica adicional en beneficio de los pacientes que están sufriendo un infarto agudo al miocardio.

In the last several years there have been increased efforts to reduce, and in the best of cases to avoid , damage to the cardiac muscle during acute myocardial infarction. Thrombolytic drugs have contributed favorably in that respect. However, there has been the need to find alternative methods of treatment to provide faster and more efective reestablishment of coronary circulation. In this paper we refer to primary coronary angioplasty as initial treatment for acute myocardial infarction. We present our first 16 patients with an evolving acute myocardial infarction treated with primary angioplasty, 15 of the 16 patients had a satisfactory course, without inhospital complications. There was one death more directly related to complications of the infarction rather than to the angioplasty procedure itself. In this way we reinforce the utility of this new method of treatment, making it an alternative therapeutic option in benefit of patients with an acute myocardial infarction.

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S1409-414220000003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000300009 Tratamiento de la disfunción contráctil severa del ventrículo izquierdo mediante marcapaso bicameral Lanzoni Rodríguez Allan Mauricio Araya Gómez Vivien ,CCSS Hospital Dr. R.A. Calderón Guardia 12 2000 2000 2 68 72 Pitt B Zannad F Remme W The effect of spironolactone on morbidity and mortality in patients with severe heart failure N Engl J Med 1999 341 Packer M Bristow MR Cohn JN The effect of carvedilol on morbidity and mortality in patients with chronic heart failure N Engl J Med 1996 334 Iskandrian AS Mintz GS Pacemaker therapy in congestive heart failure: a new concept based on excessive utilization of the Frank Starling mechanism Am Heart J 1986 112 Feldman MD Alderman JD Araesty JM Depression of systolic and diastolic myocardial reserve during atrial pacing tachycardia in patients with dilated cardiomyopathy J Clin Invest 1988 82 Pilla P Polidori DJ Pusca SV Ten weeks of rapid ventricular pacing creates a long-term model of left ventricular dysfunction J Thorac Cardiovasc Surg 2000 119 Hochleitner M Hörtnagi H Choi-Keung NG Usefulness of physiologic dual chamber pscing in drug resistent idiopatic dilated cardiomyopathy Am J Cardiol 1990 66 San Román D García-Fernandéz MA Torrecilla EG Moreno M Delcán JL Evaluación de la función diastólica: isótopos o ultrasonido? Perspectiva ecocardiográfica Rev. Esp. Cardiol 1995 48 Brecker S Xiao H Sparrow J Gibson D Effects of dual chamber pacing with short atrioventricular delay in dilated cardiomyopathy Lancet 1992 340 Guardigli G Ansale L Percoco GF AV dely optimization and management of DDD paced patients with dilated cardiomyopathy PACE 1994 17 Nishimura RA Hayes DL Holmes DR Tajik AJ Mechanism of hemodinamic improvement by dual-chamber pacing for severe left ventricular dysfunction: an acute doppler and catheterization hemodynamic study J Am Coll Cardiol 1995 25 Scanne P Lechuse E Michel L effects of temporary dual chamber cardiac pacing in refractory cardiac failure Arch Mal Coeur Vaiss 1996 89 Sack S Frank R Dagres N Can right sided atrioventricular sequencial pacing provide benefit for selected patients with severe congestive heart failure? Am J Cardiol 1999 83 Auricchio A Salo RW Acute hemodynamic improvement by pacing in patients with severe congestive heart failure PACE 1997 20 Kass DA Chen CH Curry C Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay Circulation 1999 99 Hochleitner M Hörtnagl H Hörtnagl H Fridrich L Gschnitzer F Long-term efficacy of physiologic dual-chamber pacing in the treatment of end-stage idiopathic dilated cardiomyopathy Am J Cardiol 1992 70 Shinbane J Chu E De Marco T Evaluation of acute dual chamber pacing with a range of atrioventricular delays on cardiac performance in refractory heart failure J Am Coll Cardiol 1997 30 Innes C Leitch JW Fletcher PJ VDD pacing at short atrioventricular intervals does not improve cardiac output in patients with heart failure PACE 1994 17 Linde C Gadler F Edner M Nordlander R Rosenqvist M Ryden L Results of atrioventricular synchronous pacing with optimized delay in patients with severe congestive heart failure Am J Cardiol 1995 75 Gold MR Shorofsky SR Metcalf MD Feliciano Z Fisher ML Gottlieb SS The acute hemodynamic effects of right ventricular septal pacing in patients with congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy Am J Cardiol 1997 79 Nishimura R Symanski T Hurrell D Trusty J Hayes D tajik J Dual chamber pacing for cardiomyopathies Mayo Clin Proc 1996 71 Foster A Gold M McLaughlin J Acute hemodynamic effects of atrio-biventricular pacing in humans Ann Thorac Surg 1995 59 Lanzoni AM López-Ruiz W Tratamiento con marcapaso bicameral de la obstrucción dinámica en miocardiopatías Acta Med Cost 1996 38 Cazeau S Ritter S Bakdach S Four chamber pacing in dilated cardiomyopathy PACE 1994 17 Saxon LA Kerwin WF Cahalan MK Acute effects of intraoperative multisite ventricular pacing on left ventricular function and activation/contraction sequence in patients with depressed ventricular function J Cardiovasc Electrophysiol 1998 9 Leclercq C Cazeau S Le Breton H Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure J Am Coll Cardiol 1998 32 Blanc JJ Etienne Y Gilard M Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study Circulation 1997 96 Auricchio A Stellbrink C Block M Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure Circulation 1999 99 Auricchio A Klein H Tockman B Transvenous biventricular pacieng for heart failure: can the obstacles be overcome? Am J Cardiol 1999 83
S1409-414220000003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000300010 Electrocardiograma Araya Gómez Vivien ,CCSS Hospital Dr. R.A. Calderón Guardia 12 2000 2000 2 74 74
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S1409-414220000003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000300001 Speranza Sánchez Mario , 12 2000 2000 2 02 02