S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300001 Speranza Sánchez Mario O. , 12 2002 2002 4 03 03
S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300002 Estudio de factores trombogénicos en pacientes menores de 45 años con infarto del miocardio Chavez B Liliana Solazar Lisbeth Brilla S Alfredo Herrmann F H. ,CCSS Hospital San Juan de Dios Servicio de Cardiología San José Costa Rica ,Universidad de Costa Rica Centro de Hemoglobinas Anormales y Trastornos Afines ,Institut Für Human Genetic Greifswold Alemania 12 2002 2002 4 05 10

Introducción: El estudio se orientó a buscar trombofílias en pacientes jóvenes con infarto del miocardio tanto genéticas, como las de las proteínas anticoagulantes. Material y Métodos: Las pruebas de laboratorio que se usaron para la medición del fibrinógeno fue el método de Clauss, para la proteína C y Antitrombina III (ATIII) se utilizó un método cromogénico, para la S un método coagulométrico y las pruebas genéticas por Reacción de Cadena Polimerasa (PCR). Se seleccionaron 51 pacientes jóvenes menores de 45 años con infarto agudo del miocardio y 43 pacientes sanos de grupo control de las mismas edades. Resultados: Se encontró un 85% de pacientes masculinos y 15% femeninos. Las variables que fueron factores de riesgo estadísticamente significativas fueron el sexo P = 0.0023 demostrando que por cada 4.19 hombres que sufren infarto existe una mujer. El índice de masa corporal fue significativamente mayor en los pacientes infartados con un valor de P = 0.002733 y existió asociación estadísticamente significativa con obstrucciones coronarias. La hipertensión también fue estadísticamente significativa valor de P = 0.00167. Para el nivel de colesterol total la media en los pacientes sanos fue de 166mg/dl contra 213mg/dl en los pacientes con infarto con un valor de P =0.000527mg/dl. Para el HDL colesterol el 78% de los pacientes infartados tenían niveles iguales o menores de 35mg/dl y existió asociación estadísticamente significativa con la presencia de obstrucciones coronarias. El nivel de triglicéridos mostró una asociación estadísticamente significativa con un valor de P = 0.000161 mg/dl. El 58 % de los pacientes infartados tenían un nivel elevado de LDL colesterol. En el análisis de las proteínas anticoagulantes la población enferma tuvo niveles significativamente menores que el grupo control tanto para la proteína S y la C. En el análisis de los cruces hay una asociación estadísticamente significativa entre la frecuencia alélica de la mutación de la enzima metiltetrahidrofolato reductasa y tener niveles menores de las proteínas C y S tanto en los pacientes enfermos como en los sanos que son homocigotas a la mutación. No hubo asociación estadísticamente significativa para el factor V Leyden y la variable 20210 de Protrombina. Conclusión: En los pacientes menores de 45 años con Infarto del Miocardio existen claros marcadores de riesgo para enfermedad coronaria al compararlos con sujetos sanos de una edad similar.

lntroduction: The study was orientated towards finding thrombophylia in young patients with genetic myocardium infarct as with anticoagulant proteins. Material and Methods: The lab Test used for the fibrinogen was the Clauss Method, for the C protein and ATIII a chromogenic method was used, for the S protein a coagulometrical method and for the genetic testing, PCR. Fifty one young patients were chosen (under 45 years of age) with acute myocardium infarct and 43 healthy patients in the control group in the same age range. Results: An 85% of the patients were male and 15% female. The variable that was a statistically significant risk factor was the gender (P= 0.0023) showing that for every 4.19 men that suffer an infarct there is one woman. The body mass index was substantially higher with infarcted patients (P=0.002733) which had a statistical significant association with coronary obstructions. Hypertension was also statistically significant (P = 0.00167). Mean value for total cholesterol was 166mg/dl in healthy patients versus 213mg/dl with infarcted patients (P = 0.000527mg/dl). A 78% of patients with infarct had HDL cholesterol levels of 35mg/dl or lower and showed a statistically significant association with coronary obstructions. Triglycerides levels also showed a statistically significant association (P= 0.0001 61 mg/dl). A 58% of patients with infarct showed high levels of LDL cholesterol. The analysis of anticoagulant proteins in the sick group resulted in lower levels of S and C versus the control group. Analyzing the crosses, there is a statistically significant association between the allelic frequencies in the mutation of the MTHFR enzyme and having normal levels of C and S protein in the healthy as well as in the control group. There was no statistical significant association in the for the Leyden V factor and the 20210 prothrombin factor variable.

 Trombosis infarto proteínas anticoagulantes y factores genéticos Thrombosis infarct anticoagulant proteins and genetic factors Simon G Thompson M.A Joachim kienast, M.D.,et al Hemostatic factors and the risk of infarction or sudden death in patients with angina pectoris N engl J med 1995 332 John H Griffin José A fernández Hiroshi Deguhi Plasma Lipoproteínas, Hemostasis and thrombosis Thromb Haemost 2001 86 Neil Abramson MD Simeon Abramson MD Hypercoagulabilidadty: Clinical Assessment and treatment South Med J 2001 94 ^s10 Roger L Bick Hypercoagulabilidad y trombosis Clínicas de Norte América 1998 82 Lane DA Casp R Antitrombin: structure, genomic organization,funtion and inhereted deficiency Antitrombin: structure, genomic organization,funtion and inhereted deficiency 1989 London Bailliere *s Clinical Haematology. Tuddenham E G D ed Rosendaal FR Koster T Vandenbroucke JP Resitsma PH High risk of thrombosis in patients homozygous for factor V leyden (activated protein C resistance) Blood 1995 85 Dahlback S Carlsson M Svensson PJ Familiar Thrombophilia due to a previously unrecognized by poor anticoagulant response to actived protein C: Prediction of a cofactor to actived protein C Proc Natl Acad Sci 1993 90 Dahiback S Hidebrand S Inherited resistance to actived protein C is corrected by anticoagulant co factor activity found to be a property of factor V Proc Natl Acad Sci 1994 91 Carine JM Doggen Msc Volkert Mangee Cats MD Rogier M Bertina Friots R Rosendaal MD lnteraction of coagulation Defects and Cardiovascular Risk Factors Circulation 1998 97 Rosendaal FR Siscovich DS Schwartz SM Psaty BM Raghunathante Vos HL A common prothrombin variant 20210 (G to A) increases the risk of myocardial infarction in young women Blood 1997 90 Boushey C Beresford SAA Omenn GS Motulsky AG A quantitative assessment of plasma homocysteine as a risk factor for vascular disease JAMA 1995 274 Frosst P Bloom H J Milos R Goyette P Sheppard CA Matthewes R G Boers G.J van den Heijer Mikiuijmans LAJ VandenHeurel LP Rosen R A candidate genetic risk factor for vascular disease: a common mutation in methylenetetrahydrofolate reductasa Nature Genet 1995 10 Sohda S Arinami T Hamada H Llamada N Hamuguchi H Kubot methylenetetrahydrofolate reductasa polymorphism and pre-eclampsia J. Med Genet 1997 34 Kang S S Wong P W K Susmano A Sora J Norusis M Am. J Hum Genet 1991 48 Engbersen A M T Franken D G Boers G H J Sterens E M B Trijbeis F J M Blom H J Thermolabile 5,10 methylenetetrahydrofolate reductase as a cause of mild hyperhomocysteinemia Am J Hum Genet 1995 56 Fross P Blom H J Milos R Goyette P Sheppard C A Matthews R G Boers G J H Den Heijen M Kiuijtmans L A J Van den Heuvel L P Rozen R A candidate genetic risk factor for vascular disease a common mutation in methylene tetrahydrofolate reductase Nature Genetics 1995 10 Ma J Stampfer M J Hennekens C H Frosst P Selhub J Horsford J Malinow M R Willett W C Rozen R Methylene tetrahydrofolate reductase as a risk of Myocardial infarction U.S. Physicians U.S. Physicians Mandel H Brenner B Berant M Rosenberg N Lanir N Jakobs C Fowler B Seligsonhn U Coexistence of hereditary homocysteinuria and factor V Leyden effect on on thrombosis N. Engl J Med 1996 334 Jacques P F Bostom A G Williams R R Ellison R C Eckfeldt H Rosenberg I H Relation between folate status, a commo mutation in methylenetetrahydrofolate reductase 0 and plasm homocysteine concentrations Circulation 1996 93 Herrmann FH Schroder W Salazar Sánchez L Koesling M Perez-Requejo J L Vizcaino G Aitman R Jiménez- Bonill R Herrman HF Prävalenz der molekularen Marker Faktor V Leiden MTHFR- Mutation C667 Tund des G20210 A-Polymorphismus de Prothrombingens in NO- Deutschiand und in verschiedene Populationen Latein-Amerikas sowie bei Thrombopeparenan Molekulare (DNA) Diagnostik Hereditäre Hämostasedefekte Molekulare (DNA) Diagnostik Hereditäre Hämostasedefekte 1999 19 99 Berlin Verlag Pabst Science Publishers Lengerich J Am Coll Cardiol 1996 27 Bethesda Conference Matching the intensity of Risk Factor Management with the Hazard for Cornary Disease Events ^s5 Kannel WB Wolf PA Castelli W P Agostino RB.Fibrinoge and risk of cardiovascular disease: The Framingham study JAMA 1987 258 Heinrich J Balleisen L Schulte H Assman G van de Loo J fibrinogen and factor VIl in the prediction of coronary risk : Results from the PROCAM study in healthy men Arterioscler Thromb 1994 14 Cremer P Nagel D Labrot B Mann H Muche R Eister H Seidel D Lipoprotein Lp(a) as predictor of myocardial infarction in comparison to fíbrinogen, LDL colesterol and other risk factors: Results from the prospective Gottiengen Risk incidence and Prevalence Study(GRIPS) Europ J Clin Invest. 1994 24 Ellen L. Mayer MD Donald W Jacobsen PHD Homocysteine and Coronary Atherosclerosis JACC 1996 27
S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300003 Revascularización coronaria sin circulación extracorpórea: Unidad de Cirugía Cardiovascular "UNICAR" Guatemala C.A. Bonilla Rodolfo Sánchez Córdova Juan Carlos Guzmán Ovalle Julio Enrique Cabrera Escobar José Alfonso Galindo Jorge Cruz Molina José Raúl Espada Rafael ,Unidad de Cirugía Cardiovascular UNICAR Guatemala 12 2002 2002 4 11 13

Introducción: Se trata de un procedimiento diferente al tradicional, el cirujano no usa la máquina Corazón-Pulmón o de circulación extracorpórea durante el mismo, en su lugar se usan instrumentos para estabilizar el área destinada para colocar el injerto coronario. Esto permite continuar con el flujo de sangre coronario natural, sin interrupción. Material y Métodos: En la Unidad de Cirugía Cardiovascular de Guatemala "UNICAR" de Agosto de 1999 a Septiembre 2002, 71 pacientes fueron operados de revascularización coronaria con éste método con edades comprendidas entre 35 y 80 años, siendo más frecuente el grupo de 51 a 55 años. Resultados: El porcentaje de Hemoductos realizados por paciente fue de 1.7%, utilizándose en todos Arteria Mamaria Interna para revascularizar la arteria descendente anterior. Se utilizó Arteria Radial en 4 casos. El promedio de estancia en cuidado intensivo fue de 24 horas en el 72%. En el 82% no hubo ninguna complicación, 2 pacientes presentaron derrame pleural (2.81%). Siete pacientes (9.85%) presentaron fallo cardiaco que resolvió en las primeras 48 horas. Un paciente desarrolló Infarto del Miocardio trans-operatorio sin ninguna repercusión hemodinámica (1.4%). La mortalidad fue del 2.85% (2 pacientes) que desarrollaron uno neumonía postoperatoria y el segundo hizo fallo multisistémico por sepsis de causas no cardíacas. Conclusiones: La Revascularización Coronaria sin Circulación Extracorpórea reduce el trauma del músculo cardíaco y órganos blandos. La recuperación es rápida y disminuye la estadía hospitalaria. Reduce el riesgo de sangrado, accidente cerebrovascular y fallo renal. Reduce los problemas psicomotores y cognositivos que se presentan en el método tradicional, la morbi-mortalidad es baja.

lntroduction: Beating heart Bypass is different from tradicional bypass surgery because is performed while the heart continues with his beating. The surgeons do not use the heart-fung machine, or cardiopulmonary bypass. Methods: In the Department of Cardiovascular Surgery in Guatemala, during the period from August 1999 to September 2002, seventy one patients underwent to coronary bypass grafting, beating heart. The median age was 57 years (range from 35 to 80). The range mostly affected was from 51 to 55 years. Results: A mean of 1.70% grafts per patients was performed. The left internar Mammary Artery graft used for left anterior descending artery in 100%. The Radial Artery was used in 4 cases. The length of Intensive care staying was 24 hours (72%). Mortality is 2.85% (2 patients). 1 patient died due pneumonia in 72 hours after surgery. 1 patient died due septicemia in 2 weeks after coronary bypass surgery. Conclusion: Reduce trauma. Quickly recovery and decreased of hospital staying. Reduce risk of bleeding, stroke and renal failure. Reduce psychomotor cognitive problems.

 Injerto Coronario Cirugía sin Circulación Extracorpórea Coronary Artery Bypass Surgery without the Use of Extracorporeal Circulation Vineberg AM Development of an anastomosis between the coronary vessel and a transplated internal mammary artery Can Med Assoc J 1946 Sabinston DC The coronary circulation Johns Hopkins Med J 1974 134 Koiessov VI Mammary artery-coronary artery anastomosis as method of treatment for angina pectoris J. Thorac Cardiovasc Surg 1967 54 Anjeny JL To use or not to use the pump oxygenator in coronary bypass operations Ann Thorac Surg 1975 19 Trapp WG Bisarya R Replacement of coronary artery bypass graft without pump oxygenator Ann Thorac Surg 1975 19 Bennetti FJ Naselli G Wood M Geffner L Direct myocardial revascularization without extracorporeal circulation. Experience in 700 patients Chest 1991 100 Buffolo E Succi AJ Leao LEV Galluci C Direct myocardial revascularization without cardiopulmonary bypass J Thorac Cardiovasc Surg 1985 33 Buffolo E Mini-invasive coronary bypass grafting: The Fearing method Ann Thorac Surg 1966 62
S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300004 Angina de pecho con arterias angiográficamente normales: características epidemiológicas y clínicas Gutiérrez Sotelo Oswaldo Sáenz Norton Marco Vásquez Torres Gerardo Romero Triana Luis Esquivel Alfaro Lidieth ,CCSS Hospital México Servicio de Cardiología San José Costa Rica 12 2002 2002 4 15 20

Introducción: Las lesiones obstructivas por arterioesclerosis coronaria genera diversos síndromes coronarios. Sin embargo, un subgrupo de pacientes con angina de pecho y alteraciones electrocardiográficas no presenta dichas lesiones, en el que se incluyen el vasoespasmo coronario, la angina microvascular, los puentes musculares y otras condiciones. En este estudio se evaluaron las principales características clínicas y electrocardiográficas de este grupo de pacientes. Material y métodos: Se incluyeron pacientes con cualquier síndrome coronario y angiografía coronaria sin lesiones obstructivas. Se consignaron los factores de riesgo cardiovascular, los síntomas de presentación, alteraciones electrocardiográficas y ecocardiográficas y los fármacos utilizados. Resultados: Se reclutaron 26 casos, 13 hombres y 13 mujeres con edad promedio de 56.6 años (rango 16 - 78). Se presentó angina microvascular en 16 casos, vasoespasmo coronario en 8, uno con un puente coronario y uno con flujo lento. Como síntomas se observó disnea en 18 pacientes, angor típico en 19 y angor atípico en 7. El electrocardiograma de reposo fue anormal en 18 pacientes, y el de esfuerzo en 13 casos. De 19 ecocardiogramas, 9 fueron anormales. Los fármacos más utilizados fueron los betabloqueadores, los bloqueadores de los canales del calcio y los nitratos. Conclusiones: Los pacientes con síndromes coronarios y angiografía coronaria sin lesiones obstructivas presentan frecuentemente factores de riesgo coronario, no hay diferencia de género y los exámenes auxiliares son anormales lo que motiva la realización de la angiografía.

lntroduction: Coronary arteriosclerosis lesions induce several coronary syndromes. Some patients suffer angina pectoris with abnormal electrocardiograms with no obstructive plaques in the angiogram. This group includes coronary vasospasm, micro vascular angina, muscle bridges and others. This study evaluates the most important clinical and electrocardiograghic findings among this group of patients. Material and Methods: Patients with coronary syndromes and normal coronary angiogram were included. Cardiovascular risk factors were assessed also clinical presentation, electrocardiographic and echocardiographic findings and most frequently used drugs in the hospital. Results: 26 patients were included, 13 male and 13 female with a mean age of 56.6 years (range 16-78). Micro vascular angina was present in 16 cases, coronary spasm in 8, one patient with Muscle Bridge and one with coronary slow flow. Symptoms included dyspnea in 18 patients, typical angina in 19 and atypical angina in 7. electrocardiogram at rest was abnormal in 18 patients. From 9 echocardiographic studies, 9 were abnormal. Drugs most frequentiy used inciuded betablockers, calcium channel blockers and nitrates. Conclusions: Patients with angina and normal coronary angiogram frequently have cardiovascular risk factors, there was no difference regarding gender and ancillary studies were abnormal indicating the coronary angiographic procedure.

 Angina de pecho Coronarias angiográficamente normales Takano M Mizuno K Okamatsu K Yokoyama S Ohba T Sakai S Mechanical and structural characteristics of vulnerable plaques: analysis by coronary angioscopy and intravascular ultrasound J Am Coll Cardiol 2001 38 ^s1 Tun A Khan IA Myocardial infarction with normal coronary arteries: the pathologic and clinical perspectives Angiology 2001 52 ^s5 Shah PK Pathophysiology of coronary thrombosis: role of plaque rupture and plaque erosion Prog Cardiovasc Dis 2002 44 ^s5 Braunwald E. Tratado de cardiología Tratado de cardiología 1999 2 McGraw Hill Interamericano Kaski JC Chest pain and normal coronary arteriograms: role of "microvascular spasm" Lancet 1998 351 ^s9110 Reis SE Holubkov R Conrad Smith AJ Keisey SF Sharaf BL Reichek N Rogers WJ Merz CN Sopko G Pepine CJ Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study Am Heart J 2001 141 ^s5 Chauhan A Syndrom X, angina and normal coronary angiography Postgrad Med J 1995 71 ^s836 Kaski JC Overview of gender aspects of cardiac syndrome X Cardiovasc Res 2002 53 ^s3 Kaski JC Russo G Microvascular angina in patients with syndrome X Electrocardiol 1998 31 ^s3 Sueda S Suzuki J Watanabe K Mineoi K Kondou T Yano K Ochi T Upasani PT Wasir HS Perfil de los factores de riesgo coronario en pacientes con manifestaciones de isquemia y arterias coronarias normales Indian Heart J 1994 46 ^s6 Panza J Angina in cardiac syndrome X linked to myocardial ischemia N Engl J Med 2002 346 Lanza GA Colonna G Pasceri V Maseri A Atenolol versus amiodipine versus isosorbide-5-mononitrate on anginal symptoms in syndrome X Am J Cardiol 1999 84 ^s7 Eriksson BE Tyni-Lenné R Svedenhag J Hallin R Jensen-Urstad K Jensen-Urstad M Bergman K Physical training in Syndrome X: physical training counteracts deconditioning and pain in Syndrome X J Am Coll Cardiol 2000 36 ^s5 Adamson DL Webb CM Collins P Esterified estrogens combined with methyitestosterone improve emotional weilbeing in postmenopausal women with chest pain and normal coronary angiograms Menopause 2001 8 ^s4 Sitges M Heras M Roig E Durán M Masotti M Zurbano MJ Roqué M Sanz G Acute and mid-term combined hormona replacement therapy improves endothelial function in postmenopausal women with angina and angiographically normal coronary arteries Eur Heart J 2001 22 ^s22
S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300005 Primera experiencia en el uso de Cardioplejia sanguínea: estudio prospectivo de 200 casos sometidos a Cirugía Cardíaca en el Hospital México, San José, Costa Rica Méndez Edgar A. Segura Ten Gabriela Zamora Rojas Fernando ,CCSS Hospital México ,CCSS Hospital México San José Costa Rica 12 2002 2002 4 21 27

Introducción: Este estudio reporta la primera experiencia del uso de cardioplejia sanguínea durante la cirugía cardíaca en el hospital México y expone la importancia de su uso en cirugía cardíaca. Material y Métodos: Se estudiaron prospectivamente 200 pacientes consecutivos programados a varios procedimientos quirúrgicos cardíacos con el uso de cardioplejia sanguínea en un período comprendido entre setiembre de 1999 y febrero del 2002. Resultados: Estos 200 casos consistieron de 122 hombres y 78 mujeres con una edad promedio de 57.48 años ( rango, 26 a 28 años ). 71 pacientes salieron del arresto cardíaco con ritmo espontáneo. Doce pacientes fallecieron y 30 casos presentaron complicaciones en el postoperatorio: 9 pacientes presentaron infarto agudo al miocardio perioperatorio, 6 casos presentaron para cardiorrespiratorio, 12 tuvieron arritmias cardíacas, 3 pacientes presentaron insuficiencia cardíaca congestivo. Conclusiones: En esta experiencia preliminar, el uso de la cardioplejia sanguínea parece proveer una protección miocárdica segura y confiable durante la cirugía cardíaca, siendo un método ideal en casos de cirugías de elevado riesgo quirúrgico.

lntroduction: This study reports the first experience in the use of sanguineous cardioplegia during cardiac surgery in the Mexico Hospital and exposes the important role that this procedure plays in this type of surgery. Materials and Methods: A prospective study was carried out with 200 consecutive patients programmed for different cardiac surgical procedures with the use of sanguineous cardioplegia during the period of September 1999 to February 2002. Results: Of the 200 cases 122 were male and 78 females, all with average ages of 57.48 years. Seventy one patients carne out of cardiac arrest with spontaneous rhythm. Tweive patients died and 30 cases presentes post- surgícal complications: 9 patients presentes acute myocardium infarct, 6 cases presentes Respiratory cardiac arrest, 12 had cardiac arrhythmias and 3 patients presentes congestivo cardiac insufficiency. Conclusions: in this preliminary experience the use of sanguineous cardioplegia seems to provide a safe and refiable myocardium protection during cardiac surgery, making it an ideal method in high risk surgery.

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S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300006 Avances en el tratamiento de la hipertensión arterial con antagonistas de los receptores de angiotensina Barrios Vivencio Tomás Juan Pablo Ruilope Luis Miguel ,Hospital Ramón y Cajal Madrid España ,Hospital 12 de Octubre Madrid España 12 2002 2002 4 29 37 Benegas JR Rodríguez-Artalejo F De la Cruz Troca JJ Guallar-Castilión P Del Rey Calero J La presión arterial en España. Distribución, grado de conocimiento, control y beneficios de una reducción en los niveles medios de presión arterial Hipertensión 1999 32 González Juanatey JR Alegria Ezquerra E Lozano Vidal JV llisterri Caro JL García Acuña JM González Maqueda I Impacto de la hipertensión en las cardiopatías en España. 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S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300007 Tratamiento endovascular inmediato con stent graft en laceración de aorta torácica traumática Gómes Marques R. Deluca C. Escolar E. Ahualí P. Sztejfman C. Bettinotti M. ,Sanatorio Güemes Buenos Aires Argentina ,Sanatorio Güemes Buenos Aires Argentina 12 2002 2002 4 39 42

Paciente de 32 años, que ingresa a la sala de guardia por sufrir politraumatismo secundario a accidente automovilístico. Se le realiza Rx de tórax que evidencia ensanchamiento de mediastino con sospecha clínica y por estudios con TAC y ecotransesofágico de rotura de aorta torácica, confirmada por angiografía de aorta descendente que muestra una imágen compatible con pseudoaneurisma. Debido a que la paciente persiste hipotensa, se decide tratamiento inmediato por vía endovascular, colocando un stent graft expandible con balón, con resultado exitoso y sin complicaciones. En el seguimiento con TAC con contraste al mes, a los 6 meses y al año, no se observaron alteraciones de la prótesis ni leaks peri protésico o re-estenosis.

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S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300008 Síndrome de Cimitarra: a propósito de dos casos recientes Flores Badilla Alejandra Alvarado González Alcibey Mas Romero Carlos ,Universidad de Costa Rica ,CCSS Hospital San Juan de Dios ,CCSS Hospital Nacional de Niños San José 12 2002 2002 4 43 45 Topol EJ Textbook of Cardiovascular Medicine Textbook of Cardiovascular Medicine 2002 Philadeiphia^ePA Lippincott Williams & Wilkins Halasz NA Halloran KH Liebow AA Bronchial and arterial anomalies with drainage of the right lung into the inferior vena cava Circulation 1956 14 Gilkenson Case report: Scimitar syndrome AJR Am J Roentgenol 1997 169 Mas C Goh TH Wilkinson Jl New interventional therapeutic approach for dual drainage of the scimitar vein Cathet Cardiovasc lntervent 2000 51 Depuis C Charaf L Breviére "infantile" form of the Scimitar Syndrome with pulmonary hypertension Am J Card 1993 71 Kivelitz DE Scheer I Taupitz M Scimitar syndrome: Diagnosis with MR angiography AJR Am J Roentgenol 1999 172 ^s6 Freedom RM Mawson JB Yoo SJ Benson LN Congenital Heart Disease: Textbook of Angiocardiography Congenital Heart Disease: Textbook of Angiocardiography 1997 2 Futura Publishing Company Depuis C Charaf L Breviére The "aduit" form of Scimitar Syndrome Am J Card 1992 70 Cirillo Robert L The Scimitar Sign The Scimitar Sign 1998 206 Mo Christopher B Scimitar syndrome J Emerg Med 2001 21 ^s3 MC Loud C. T. Thoracic radiology: Congenital abnormalities of the thorax Thoracic radiology: Congenital abnormalities of the thorax 1998 Saint Louis Mosby Huddleston CB Exil V Canter CE Scimitar syndrome presenting in infancy Ann Thorac Surg 1999 67 Najm HK Williams WG Coles JG Scimitar syndrome: twenty years' experience and results of repair J Thorac Cardiovasc Surg 1996 112
S1409-414220020003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422002000300009 Araya Gómez Vivien , 12 2002 2002 4 46 46