S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100001 Se busca... Speranza S Mario , 01 2005 2005 7 03 03
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100002 Síncope: estrategia diagnóstica, utilidad del holter implantable Araya Gómez Vivien ,Centro Cardiológico Integral San José Costa Rica 01 2005 2005 7 04 04
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100003 Utilización de la Máscara Laringea (ML) en pacientes pediátricos (PP) Tibaldi Miguel ,Universidad Católica de Córdoba FUCCADIM Córdoba Argentina 01 2005 2005 7 07 14

Objetivo: presentar la experiencia con el uso de la ML en la anestesia de los PP durante el cateterismo cardíaco. Método: Se realizó el análisis retrospectivo de 127 cateterismos en 120 pacientes pediátricos. Los datos fueron obtenidos de historias clínicas, fojas quirúrgicas y hojas de sala del servicio de hemodinamia de pacientes pediátricos con cardiopatías congénitas sometidos a cateterismos diagnósticos y terapéuticos. Resultados: De los 127 cateterismos se recabó la información completa en 88. De éstos, 43(48%)pacientes fueron del sexo femenino y 45(52%)del sexo masculino, El peso osciló entre 2. 7 y 68 kg y las edades entre 12 horas y 14 años. La duración de los procedimientos entre los 45 min y 2, 45 horas. Los estudios correspondieron 66 a estudios diagnósticos, 9 valvuloplastias, 4 septostomías, 1 pericardiocentesis, 4 angioplastias (2 coartaciones aórticas 2 a ramas pulmonares), 2 cierre de fístula con coil y cierre de DAP 2 con coil. Se utilizó Sevofluorano a dosis altas (8%)en la inducción, la ML se colocó en plano anestésico, y posteriormente se disminuyó la concentración para mantenimiento en un plano no profundo, manteniendo la ventilación espontánea y se la retiró en el mismo plano. Uno (1. 1%)de los pacientes presentó espasmo laringeo severo que requirió de intubación endotraqueal como complicación, el resto de los pacientes salieron de la sala de hemodinamia vigiles, con ventilación espontánea y buena dinámica respiratoria. Conclusión: La utilización de la ML en la anestesia de PP es un método seguro, de fácil instrumentación, con menor invasión de la vía aérea, que permite una segura utilización de gases anestésicos y adecuado control oximétrico con baja incidencia de complicaciones.

Objective: to present our experience with the use of laryngeal mask (LM)during anesthesia for cardiac catherization in pediatric patients (PP). Methods: One hundred and 20 patients underwent a total of 127 cardiac catherization procedures. Their cases were analyzed retrospectively. The information was obtained from medical records, operative notes and cath lab reports from PP who underwent diagnostic and therapeutic procedures. Results: Only 88 procedures out of the 127 had complete information. There were 43 females (48%)and 45 males (52%). The patients' weight ranged between 2. 7 to 68 kgs and their ages between 12 hours to 14 years old. The procedures lasted from 45 minutes to 2. 45 hours. Sixty-six procedures were diagnostic, 9 were valvuloplasties, 4 septostomies, 1 pericardiocentesis, 4 angioplasties (2 of aortic coarctation and 2 of pulmonary artery branches), 2 coil closures of a leak and 2 ductus coil closures. Sevoflourane at high concentrations (8%)was used for induction. The LM was inserted when the patient reached anesthetic level and then this gas was cut back to keep the patient in a lighter plane, maintaining spontaneous ventilation and then it was discontinued all together. One patient (1.1%)presented severe laryngeal spasm that required endotraqueal intubation, the rest of the patients came out of the cath lab alert and with spontaneous ventilation and normal respiratory parameters. Conclusions: The utilization of LM for PP anesthesia is a safe method, is easy and it involves less airway invasion and it permits utilization of gases and adequate oxymetric control with low complication index.

 Máscara laringea edad pediátrica Cateterismos cardíacos laryngeal mask pediatric age Brimacombe J. R Berry A Cánula de mascarilla laríngea Cánula de mascarilla laríngea 1995 Interamericana Pennant J. M. A B M Anaes F. R. C White W The laryngeal Mask Airway, Its uses in Anesthesiology Anesthesiology Jul. 1 99 79 1 Brimacombe JR Berry AM Campbell RC Selection of proper size of lanryngeal mask airway in adults Anesth Analg 1996 83 Tesuro Kagawa Hidelfumi Obara M. D An easy fórmula to remember the Lageal Mask Airway Size-Patient Weght Relationship An easy fórmula to remember the Lageal Mask Airway Size-Patient Weght Relationship Brain AIJ The development of the laryngeal mask-a brief history of the invention, early clinical studies and experimental work from which the laryngeal mask envolved Eur J. Anesthesiol 1991 4 Coryne BJ The use of the laryngeal mask in day case and short stay surgery Ir. J Med Sci 1990 159 Hugues JA Gataure PS Pattern of use of the larybgeal mask airway Anesthesia 1992 47 Brain AIJ Déja vu (letter) Br. Br. Anesth 1990 6-4 Branbrink AM Meyer RR Management of pediatric airway -anatomy, physiology and developments in clinical practice Anesthesiol Reanim 2003 28 6 Brain AIJ The laryngeal mask: A new concept in airway manegement Br. J. Anaesth 1983 55 Benumof J Séller M The importance of transtracheal jet ventilation in manegement of the difficult airway Aesthesiology 1989 71 Baeza F Leyton P Grove E Vía aerea difícil: Manejo y rendimiento de Aparatos Vía aerea difícil: Manejo y rendimiento de Aparatos 2000 Setiembre Walker RW The laryngeal mask airway in the difficult paediatric airwa: a assessment of posiyioning and use in fibreoptic intubation Paediatric Anaesth 2000 10 1 Yuan-Shion Huan Jeng-Tieng Shen Pulmonary Aspiration Associated with Laryngeal Mask Airway General Anesthesia J. Med. Sci 2004 24 3 Keller C Brimacombe J Aspiration and the laryngeal mask airway: three cases and a review of the literature Aspiration and the laryngeal mask airway: three cases and a review of the literature Blitt CD Gutman HL Cohen DD Silent regurgitation and aspiration durin the general anesthesia Anest. Analg 1979 49 Tetsuro Kagawa MD Hidefumi Obara MD An easy formula to remember the Laryngeal Mask Airway Size-Patient Weight Relationship Anesthesiology 2000 F eb 92 2 Takashi Asai MD Tracheal Intubation through the laryngeal Mask Airway Anestesiology 1996 A ug 85 Jean Reignier MD Mondler ben ameur Spontaneus ventilation whith halotane in children: a comparative Study betwen Endotracheal Tube and Laryngeal Mask Airway Anesthesiology 1995 83 Keidan I Gavin F Work of Breathing During Spontaneus Ventilation in Anesthetized Children: a comparative Study Among the Face Mask, Laryngeal Mask Airway, and Endotracheal Tube Work of Breathing During Spontaneus Ventilation in Anesthetized Children: a comparative Study Among the Face Mask, Laryngeal Mask Airway, and Endotracheal Tube Lopez gil M Brimacombe J Laryngeal Mask Airway in pediatric practice: a prospective study of Skill Acquisition by Anesthesia Residents Laryngeal Mask Airway in pediatric practice: a prospective study of Skill Acquisition by Anesthesia Residents Zanardo V Simbi AK Savio V Neonatal ressiscitation by laryngeal mask airway after elective cesarean section Fetal Diagn Ther 2004 M ay 19 3 Ahyon-Bahk J Sung J A comparison of ketamine and lidocaines Spray with propofol for the insertiion of Laryngeal Mask Airway in Children: A double-Blinded Randomized Trial Anesth Analg 2002 95 Yazbeck-Karam VG Aouad MT Laryngeal mask airway for ventilation during diagnostic and interventional fibreoptic bronchoscopy in children Paediatr Anaesth 2003 O ct 13 8 Bennett SR Grace D Griffin SC Cardiovascular changes with the laryngeal mask airway in cardiac anaesthesia Br.. J. Anaesth 2004 J un 92 6 Frediani M Blanchini G The laryngeal mask in pediatric anestesia Minerva Anestesiol 1996 . Ma 62 3
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100004 Síncope: Estrategia diagnóstica. Utilidad del Holter Implantable Escobar Cervantes Carlos Barrios Alonso Vivencio Hernández Madrid Antonio Echarri Carrillo Rocío Amador Alejandro ,Hospital Ramón y Cajal Servicio de Cardiología Madrid España 01 2005 2005 7 15 22

Se puede definir el síncope como una pérdida breve y súbita del nivel de conciencia que se asocia a una pérdida del tono postural, con recuperación espontánea. La fisiopatología de todas las formas de síncope consiste en un descenso brusco del flujo sanguíneo cerebral. El síncope es una patología común, invalidante y que se asocia posiblemente a un riesgo de muerte súbita, aunque sus causas son en ocasiones difíciles de determinar y precisa de numerosas pruebas diagnósticas. Una historia clínica cuidadosa junto con una exploración física completa son esenciales en la evaluación del síncope y deben conducir o al menos sugerir el diagnóstico que debe ser confirmado mediante distintas pruebas. El electrocardiograma se recomienda en todos los pacientes, a pesar del bajo rendimiento pues los hallazgos pueden ayudar a tomar decisiones para el manejo inmediato de la causa subyacente (por ejemplo, la implantación de un marcapasos en un bloqueo auriculoventricular completo) o para el planteamiento de futuras pruebas diagnósticas. Tras el análisis inicial (historia clínica, exploración física y electrocardiograma) las pruebas diagnósticas a realizar se harán según la sospecha clínica. Sin embargo, existe poca información acerca de la utilidad del holter implantable en el manejo diagnóstico del síncope. Este artículo pretende hacer una revisión sobre la evaluación del síncope así como el papel que juega el holter implantable en el manejo diagnóstico del síncope.

Syncope is a sudden and brief loss of consciousness associated with a loss of postural tone, with spontaneous recovery. The pathophysiology of all forms of syncope consists of a sudden decrease or a brief cessation of cerebral blood flow. Syncope is common, disabling, and possibly associated with a risk of sudden death, but its causes are difficult to diagnose. Consequently, syncope often leads to hospital admission, multiple consultations, and the performance of many diagnostic tests. A carefully taken history and physical examination are essential for the evaluation of syncope and they may lead to or suggest a diagnosis that can be documented by specific testing. Electrocardiography in spite of its low yield, is recommended in almost all patients, since its findings can lead to decisions regarding the immediate management of an underlying disease (e.g., implantation of a pacemaker for complete heart block) or it can help in planning further testing. Based on the initial assessment (history, physical examination and electrocardiogram), the diagnostic evaluation should proceed as clinically suspected. However, there is still poor information about the usefulness of an implantable loop recorder in the diagnosis of syncope. This article provides an approach to the evaluation of syncope and the usefulness of an implantable loop recorder.

 síncope holter implantable diagnóstico Syncope implantable loop recorder diagnosis Bergfeldt L Differential diagnosis of cardiogenic syncope and seizure disorders Heart 2003 89 Day SC Cook EF Funkenstein H Goldman L Evaluation and outcome of emergency room patients with transient loss of conciousness Am J Med 1982 73 Kapoor W Syncope in older persons J Am Geriatr Soc 1994 42 Madrid AH Ortega J Rebollo JG Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double blind, randomized and placebo-controlled study J Am Coll Cardiol 2001 37 Linzer M Yang EH Estes NA Diagnosing syncope. Part 1: value of history, physical examination, and electrocardiography. Clinical efficay assessment project of tha American College of Physicians Ann Intern Med 1997 126 Kapoor WN Fortunato M Hanusa BH Schulberg HC Psychiatric illnesses in patients with syncope Am J Med 1995 99 Martin GJ Adams SL Martin HG Mathews J Zull D Scanlon PJ Prospective evaluation of syncope Ann Emerg Med 1984 13 Krahn AD Klein GJ Norris C Yee R The etiology of syncope in patients with negative tilt table and electrophysiological testing Circulation 1995 92 Peinado R Merino JL Empleo selectivo de pruebas diagnósticas en el síncope de causa no aclarada: Utilidad del Holter implantable Rev Esp Cardiol 2001 54 Raj SR Sheldon RS Syncope: investigation and treatment Current Cardiology Reports 2002 4 Brignole M Alboni P Benditt DG Bergfeldt L Blanc JJ Bloch PE Guidelines on management (diagnosis and tratment) of syncope-Update 2004 Eur Heart J 2004 25 Kapoor WN Syncope N Engl J Med 2000 343 Alboni P Brignole M Menozzi C The diagnostic value of history in patients with syncope with or without heart disease J Am Coll Cardiol 2001 37 Linzer M Yang EH Estes NA Diagnosing syncope. Part 2: value of history, physical examination, and electrocardiography. Clinical efficay assessment project of tha American College of Physicians Ann Intern Med 1997 127 Rodríguez García J Coma Samartín R Sánchez Sánchez V Esteve Alderete JJ El Holter implantable subcutáneo: Un nuevo instrumento para el diagnóstico del síncope de origen no determinado Rev Esp Cardiol 1998 51 Schuchert A Maas C Kretzschmar C Diagnostic yield of external loop recorders in patients with recurrent syncope and negative tilt table test Pacing Clin Electrophysiol 2003 26 Belchí Navarro J Quesada Dorador A Atienza Fernández A Villalba Caballero S Roda Nicolás J de Velasco Ramí J Síncope y estudio electrofisiológico negativo: Utilidad del Holter implantable para el diagnóstico de arritmias ventriculares Rev Esp Cardiol 1999 52 Martí Almor J Delclòs Urgell J Bruguera Cortada J Disfunción sinusal atípica: Utilidad del Holter implantable. A propósito de un caso Rev Esp Cardiol 2001 54 Lee RT Cook EF Day SC Long-term survival after transient loss of conciousness J Gen Intern Med 1988 3 Paylos JM Torresa RA Utilidad del registrador implantable subcutáneo Síncope. Estrategia diagnóstica. Utilidad del Holter Implantable. Dr. Carlos Escobar Cervantes, Dr. Vivencio Barrios Alonso y Col. en el diagnóstico del síncope recurrente de etiología no filiada en pacientes sin cardiopatía estructural con test de tabla basculante y estudio electrofisiológico negativos Rev Esp Cardiol 2001 54 Kenny RA Krahn AD Implantable loop recorder: evaluation of unexplained syncope Heart 1999 81 Krahn AD Klein GJ Yee R Skanes AC Randomized assessment of syncope trial: Conventional diagnostic testing versus a prolonged monitoring strategy Circulation 2001 104 García-Civera R Ruiz-Granell R Morell-Cabedo S A selective use of diagnostic tests in patients with syncope of unknow cause J Am Coll Cardiol 2003 41 Brignole M Alboni P Benditt D Guidelines on management (diagnosis and treatment) of syncope Eur Heart J 2001 22 Krahn AD Klein GJ Yee R Skanes AC Predictive value of presyncope in patients monitored for assessment of syncope Am Heart J 2001 141 Krahn AD Klein GJ Yee R Use of an extended monitoring strategy in patients with problematic syncope Circulation 1999 99 Brignole M Menozzi C Moya A Garcia-Civera R Implantable loop recorder: towards a gold standard for the diagnosis of syncope? Heart 2001 85 Menozzi C Brignole M Garcia-Civera R Mechanism of syncope in patients with heart disease and negative electrophysiologic test Circulation 2002 105 Brignole M Menozzi C Moya A Nonarrhythmic syncope documented by an implantable loop recorder (an ISSUE substudy) Am J Cardiol 2002 90 Brignole M Menozzi C Moya A Mechanism of syncope in patients with bundle branch block and negative electrophysiological test Circulation 2001 104 Benditt D G Brignole M Syncope: is a diagnosis a diagnosis? J Am Coll Cardiol 2003 41 Krahn AD Klein GJ Yee R Mand V The high cost of syncope: cost implications of a new insertable loop recorder in the investigation of recurrent syncope Am Heart J 1999 137 Kapoor W Current evaluation and management of syncope Circulation 2002 106 Krahn AD Klein GJ Yee R Cost implications of testing strategy in patients with syncope J Am Coll Cardiol 2003 42 Kürer CC Implantable loop recorders: Dollars and sense J Am Coll Cardiol 2003 42 Moya A Brignole M Menozzi C Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope Circulation 2001 104
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100005 Síndrome de QT largo congénito: revisión de las diferentes variantes y tratamientos Escobar Cervantes Carlos Echarri Carrillo Rocio Amador Borrego Alejandro Tarancón Zubimendi Belén Salido Tahoces Luisa Barrios Alonso Vivencio ,Hospital Ramón y Cajal Servicio de Cardiología Madrid España 01 2005 2005 7 23 29

El síndrome de QT largo es una entidad clínica y genéticamente heterogénea, caracterizada por la prolongación del intervalo QT en el electrocardiograma de superficie junto con una dispersión aumentada de la repolarización ventricular que asocia una predisposición a la aparición de arritmias ventriculares malignas, torsade de pointes y fibrilación ventricular, que pueden conducir a una muerte súbita cardíaca. El síndrome de QT largo afecta predominantemente a adolescentes y adultos jóvenes con corazones estructural y funcionalmente normales pero que subyace una alteración en los canales de potasio o de sodio. Se han utilizado diferentes tratamientos en el síndrome de QT largo que incluyen la corrección de la causa subyacente y de los factores precipitantes, el tratamiento antiadrenérgico (beta-bloqueantes, simpatectomía cervicotorácica izquierda), sulfato de magnesio, isoproterenol, marcapasos, desfibrilador automático implantable. A pesar de estos tratamientos, la proporción de eventos cardíacos todavía es elevada. Otros tratamientos potenciales incluyen bloqueadores de los canales de sodio, suplementos de potasio, activadores de los canales de potasio, bloqueadores alfa-adrenérgicos, bloqueadores de los canales de calcio, atropina e inhibidores de la proteincinasa. El objetivo de este artículo es revisar las diferentes variantes conocidas hasta ahora del síndrome de QT largo congénito así como de los distintos tratamientos utilizados hasta la fecha y de los nuevos avances y posibles futuras estrategias en el síndrome de QT largo y en las torsade de pointes.

Long-QT syndrome is a clinically and genetically heterogeneous syndrome characterized by lengthening of the QT interval and increased dispersion of the ventricular repolarization on the surface electrocardiogram and a propensity to malignant ventricular arrhythmias, torsade de pointes and ventricular fibrillation, which may lead to sudden cardiac death. Long-QT syndrome mostly affects adolescents and young adults with structurally and functionally normal hearts and is caused by aberrations in potassium and sodium ion channels. Different treatments have been used for long-QT syndrome. These treatments include correction of the underlying cause and the precipitating factors, antiadrenergic therapy (beta-adrenergic receptor blockers, left cervicothoracic sympathectomy), magnesium sulfate, isoproterenol, cardiac pacing, and implantable cardioverter defibrillator. In spite of these treatments the proportion of cardiac events is still high. Other potential treatments include sodium channel blockers, potassium channel activators, alpha-adrenergic receptor blockers, calcium channel blockers, atropine, and protein kinase inhibitors. The objective of this article is to go over the different variants of long-QT syndrome and the established therapies and to review the recent advances and potential future strategies in the treatment of this condition and torsade de pointes.

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Appl. Genet 2004 45 Kass R. S Moss A. J Long QT syndrome: novel insights into the mechanisms of cardiac arrhythmias J. Clin. Invest 2003 112 Priori SG Schwartz PJ Napolitano C Risk stratification in the long QT syndrome N Engl J Med 2003 348 Viskin S Fish R Zeltser D Arrhythmias in the congenital long QT syndrome: How often is torsade de pointes pause dependent? Heart 2000 83 Khan I. A Gowdab R. M Novel therapeutics for treatment of long-QT syndrome and torsade de pointes International Journal of Cardiology 2004 95 Moss AJ Long QT Syndromes Curr Treat Options Cardiovasc Med 2000 2 Khan IA Clinical and therapeutic aspects of congenital and acquired long QT syndrome Am J Med 2002 112 Koren G Electrical remodeling and arrhythmias in long-QT syndrome: lessons from genetic models in mice Ann Med 2004 36 ^s1 Fazekas T Scherlag BJ Vos M Wellens HJ Lazzara R Magnesium and the heart: antiarrhythmic therapy with magnesium Clin Cardiol 1993 16 Tzivoni D Banai S Schuger C Treatment of torsade de pointes with magnesium sulfate Circulation 1988 77 Hoshino K Ogawa K Hishitani T Kitazawa R Studies of magnesium in congenital long QT syndrome Pediatr Cardiol 2002 23 Moss AJ Zareba W Hall WJ Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome Circulation 2000 101 Krahn AD Yee R Coumel P Escoubet B Attuel P Betablocking therapy in atrial and ventricular tachyarrhythmias: experience with nadolol Am Heart J 1984 108 Villain E Denjoy I Lupoglazoff JM Guicheney P Hainque B Lucet V Low incidence of cardiac events with beta-blocking therapy in children with long QT syndrome European Heart Journal 2004 25 Priori S. 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J Grillo M Bloise R Ronchetti E Association of long QT syndrome loci and cardiac events among patients treated with beta-blockers JAMA 2004 292 Moss AJ Zareba W Hall WJ Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome Circulation 2000 101 Shimizu W Antzelevitch C Differential effects of beta-adrenergic agonists and antagonists in LQT1, LQT2 and LQT3 models of the long QT syndrome J Am Coll Cardiol 2000 35 Conrath CE Wilde AA Jongbloed RJ Gender differences in the long QT syndrome: effects of beta-adrenoceptor blockade Cardiovasc Res 2002 53 Schwartz PJ Locati E Moss A Left cardiac sympathic denervation in the therapy of congenital long QT syndrome Circulation 1991 84 Benito F Olivares P Sánchez C Denervación simpática cardíaca izquierda mediante toracoscopia en el tratamiento del síndrome de QT largo congénito Rev Esp Cardiol 2003 56 Schwartz PJ Locati EH Moss AJ Crampton RS Trazzi R Ruberti U Left cardiac sympathetic denervation in the therapy of congenital long QT syndrome. A worldwide report Circulation 1991 84 Reardon PR Matthews BD Scarborough TK Reardon MJ Left thoracoscopic sympathectomy and stellate ganglionectomy for treatment of the long QT syndrome Surg Endosc 2000 14 Viskin S Torsade de pointes Curr Treat Options Cardiovasc Med 1999 1 Van Hare GF Franz MR Roge C Scheinman MM Persistent functional atrio-ventricular block in two patients with prolonged QT interval: elucidation of the mechanism of block Pacing Clin Electrophysiol 1990 13 Eldar M Griffin JC Van Hare GF Combined used of betaadrenergic blocking agents and long term cardiac pacing for patients with the long QT syndrome J Am Coll Cardiol 1992 20 Viskin S Cardiac pacing in the long QT syndrome: review of available data and practical recommendations J Cardiovasc Electrophysiol 2000 11 Moss AJ Liu JE Gottlieb S Locati EH Schwartz PJ Robinson JL Efficacy of permanent pacing in the management of high-risk patients with long QT syndrome Circulation 1991 84 Campanelli B Chaudron JM Long term follow up of long QT syndrome treated by overdrive pacing Heart 2001 86 Viskin S Cardiac pacing in the long QT syndrome: review of available data and practical recommendations J Cardiovasc Electrophysiol 2000 11 Dorostkar PC Eldar M Belhassen B Scheinman MM Long-term follow -up of patients with long-QT syndrome treated with beta-blockers and continuous pacing Circulation 1999 100 Welde AA Is there a role for implantable cardioverter defibrillators in long QT syndrome? 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with flecainide in long QT syndrome patients with SCN5A: DeltaKPQ mutation Ann Noninvasive Electrocardiol 2001 6 Liu H Tateyama M Clancy CE Abriel H Kass RS Channel openings are necessary but not sufficient for use-dependent block of cardiac Na (+) channels by flecainide: evidence from the analysis of disease-linked mutations J Gen Physiol 2002 120 Assimes TL Malcolm I Torsade de pointes with sotalol overdose treated successfully with lidocaine Can J Cardiol 1998 14 Halkin A Roth A Lurie I Fish R Belhassen B Viskin S Pausedependent torsade de pointes following acute myocardial infarction: a variant of the acquired long QT syndrome J Am Coll Cardiol 2001 38 Carlsson L Drews L Duker G Schiller-Linhardt G Attenuation of proarrhythmias related to delayed repolarization by low-dose lidocaine in the anesthetized rabbits J Pharmacol Exp Ther 1993 267 Olsson SB Edvardsson N Newell PA Yuan S Zeng Z Effect of pentisomide (CM 7857) on myocardial excitation, conduction, repolarization, and 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S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100006 Ultrasonografía doppler transcraneal Ciancaglini Carlos ,Instituto Modelo de Cardiología Servicio de Medicina Vascular Córdoba Argentina 01 2005 2005 7 31 37 Aaslid R Markwalder T-M Norris H Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries J Neurosurg 1982 57 Ringelstein EB Otis SM Schneider PA Noninvasive assessment of CO2-induced cerebral vasomotor reactivity: Comparison with rCBF findings during 133-xenon inhalation measurement J Cereb Blood Flow Metab 1991 Otis S Ringelstein EB Bernstein DE Transcranial Doppler sonography Transcranial Doppler sonography 1990 St. Louis, CV Mosby Otis S Ringelstein EB Zwiebel WJ Transcranial Doppler sonography Transcranial Doppler sonography 1992 WB Saunders
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100007 Trauma cardíaco: una revisión práctica II Parte. Traumatismo Penetrante Méndez J Edgar A Zamora L José Zeledón S Fernando Zamora R Fernando ,C.C.S.S Hospital México San José Costa Rica ,C.C.S.S Hospital México ,C.C.S.S Hospital México San José Costa Rica ,C.C.S.S Hospital México San José Costa Rica 01 2005 2005 7 39 46 Blantchford JW Ludwing Rhen The first successful cardiorrhaphy Ann Thorac Surg 1985 39 Trinkle JK Penetrating heart wounds: Difficulty in evaluating clinical series Ann Thorac Surg 1984 38 Sugg WL Rea WJ Ecker RR Penetrating wounds of the heart: An analysis of 459 cases J Thorac Cardiovasc Surg 1968 56 Kane G Wheeler NC Cook S Impact of the Los Angeles Country trauma Trauma cardíaco: system on the survival of seriously injured patients J trauma 1992 32 Champion HR Sacco WJ Copes WS Improvement in outcome from trauma center care Arch Surg 1992 127 Rhee PM Foy H Kaufmann C Penetrating cardíac injuries: a population- based study J Trauma 1998 45 2 Kaplan AJ Norcross ED Crawford FA Predictors of mortality in penetrating cardíac injury Am Surg 1993 59 Asencio JA Berne JD Demetriades D One hundred five penetrating cardíac injuries: A 2 years prospective evaluation J Trauma 1998 44 Mandal AK Sanusi M Penetrating chest wounds: 24 years experience World J Surg 2001 25 9 Gao JM Gao YH Wei GB Liu GL Tian XY Hu P CH Li Penetrating cardíac wounds: principles for surgical management World J Surg 2004 28 10 Campbell NC Thompson SR Muckart DJ Review of 1198 cases of penetrating cardíac trauma Br J Surg 1997 84 Mesa JM Sobrino N Larrea JL Perforación del ventrículo izquierdo post valvuloplastía mitral percutánea: Corrección quirúrgica de in situ de emergencia. A propósito de un caso Rev Esp Cardiol 1991 44 Asano M Mishima A Ishii T Surgical treatment for right ventricular perforation caused by transvenous pacing electrodes: a report of three cases Surg Today 1996 26 Dominguez E Neudeck F Piotrowski J Perforation of the heart wall: a rare complication after thoracic drainge treatment Chirurg 1995 66 Panos AL Ali IS Birnbaum PL Coronary sinus injuries during retrograde continuous normothermic blood cardioplejia Ann Thorac Surg 1992 54 Gervin AS Fischer RP The importance of prompt transport in salvage of patients with penetrating heart wounds J Trauma 1982 22 Departamento de Información Estadística del la Caja Costarricense del Seguro Social: Edificio central Departamento de Información Estadística del la Caja Costarricense del Seguro Social: Edificio central San José Stratton SJ Brickett K Crammer T Prehospital pulseless, unconscious penetrating trauma victims: field assessments associated with survival J Trauma 1998 45 1 Sugg WL Rea WJ Ecker RR J Thorac Cardiovasc Surg 1968 56 Symbas PN Harlaftis N Waldo WJ Penetrating cardíac trauma Am J Surg 1976 183 Braundwald E Heart Disease Heart Disease 1988 3th Philadelphia W. B. Saunders Symbas PN Traumatic heart disease Curr Probl Cardiol 1982 7 Beck C Further observations on stab wounds of the heart Ann Surg 1942 115 Mcphee SJ Ganong WF Fisiopatología médica Fisiopatología médica 2000 2a Manual Moderno Ameli S Shah PK cardíac tamponade: pathophysiology, diagnosis, and management Cardiol Clin 1991 9 Frank MJ Nadimi M Lesniak LJ Effects of cardíac tamponade on myocardial performance, blood flow and metabolism Am J Physiol 1971 220 Moreno C Moore EE Majune JA Pericardial tamponade. A critical determinant for survival following penetrating cardíac wounds J Trauma 1986 26 Buckman RF Badellino MM Mauro LH Penetrating cardíac wounds: prospective study of influencing initial resuscitation J Trauma 1993 34 Fischer DR Kelly BS The Mound Reid Surgical HandBook The Mound Reid Surgical HandBook 2005 5o Philadelphia Elsevier Mosby Wall MJ Mattox KL Chi-Dai C Acute management of complex cardíac injuries Acute management of complex cardíac injuries 1997 42 Mattox K Feliciano D Moore EE Trauma Trauma 2001 4o McGraw Hill Mainieri JA Trauma de Torax Trauma de Torax 2000 EDNASSS Asencio JA Stewart BM Murray J Penetrating cardíac injuries Surg Clin North Am 1996 76 Tyburski JG Astra L Wilson RF Factors affecting prognosis with penetrating wounds of the heart Am Surg 1999 65 Asencio JA Murray J Demetriades D Penetrating cardíac injuries: a prospective study of variables predicting outcomes J Am Coll Surg 1998 186 America College of Surgeons Committee on Trauma: Advanced Trauma Life Support Instructor Manual America College of Surgeons Committee on Trauma: Advanced Trauma Life Support Instructor Manual 1993 Chicago American College of Surgeons Initial Assessment and Management Initial Assessment and Management 1997 Chicago^eIllinois American College of Surgeons Harris DG Papagiannopoulos KA Pretorius J Van Rooyen T Rossouw GJ Current evaluation of cardíac stab wounds Ann Thorac Surg 1999 68 6 Kramer GC Hypertonic resuscitation: physiologic mechanisms and recommendations for trauma care J Trauma 2003 54 ^s5 Nagy KK Lohmann C Kim DO Barrett J Role of echocardiography in the diagnosis of occult penetrating cardíac injury J Trauma 1995 38 6 Freshman SP Wisner DH Weber CJ 2-D echocardiography: emergent use in the evaluation of penetrating precordial trauma J Trauma 1991 31 7 Jimenez E Martin M Krukenkamp I Barrett J Subxiphoid pericardiotomy versus echocardiography: a prospective evaluation of the diagnosis of occult penetrating cardíac injury Surgery 1990 O ct 108 4 Knott-Craid CJ Dalton RP Rossouw GJ Penetrating cardíac trauma: management strategy based on 129 surgical emergencies over 2 years Ann Thorac Surg 1992 53 Andrade-Alegre R Mon L Subxiphoid pericardial window in the diagnosis of penetrating cardíac trauma Ann Thorac Surg 1994 58 4 Meyer DM Jessen ME Grayburn PA Use of echocardiography to detect occult cardíac injury after penetrating thoracic trauma: a prospective study J Trauma 1995 39 5 Rozycki GS Feliciano DV Ochsner MG The role of ultrasound in patients with possible penetrating cardíac wounds: a prospective multicenter study J Trauma 1999 46 4 Thourani VH Feliciano DV Cooper WA Penetrating cardíac trauma at an urban trauma center: a 22 year perspective Am Surg 1999 65 Patel AN Brennig C Cotner J Successful diagnosis of penetrating cardíac injury using surgeon-performed sonography Ann Thorac Surg 2003 76 6 Hoff WS McMahon DJ Schwab CW Thoracoscopic pericardial window and penetrating cardíac trauma J Trauma 1997 43 3 Morales CH Salinas CM Henao CA Thoracoscopic pericardial window and penetrating cardíac trauma J Trauma 1997 42 2 Blake DP Gisbert VL Ney AL Survival after emergency department versus operating room thoracotomy for penetrating cardíac injuries Am Surg 1992 58 Coats TJ Keogh S Clark H Neal M Prehospital resuscitative thoracotomy for cardíac arrest after penetrating trauma: rationale and case series J Trauma 2001 50 4 Aihara R Millham FH Blansfield J Hirsch EF Emergency room thoracotomy for penetrating chest injury: effect of an institutional protocol J Trauma 2001 50 6 Kennedy F Sharif S Emergency room thoracotomy: a single surgeon ’s thirteen year experience Am Surgeon 2000 66 Kavolius J Golocovsky M Champion HR Predictors of outcome in patients who undergo emergency thoracotomy Arch Surg 1993 128 Brown SE Gómez GA Jacobson LE Penetrating chest trauma: should indications for emergency room thoracotomy be limited? Am Surg 1996 62 Grabowski MW Buckman RF Goldberg A Clamp control of the right ventricular angle to facilitate exposure and repair of cardíac wounds Am J Surg 1995 170 Macho JR Markison RE Schecter cardíac stapling in the management of penetrating injuries of the heart: rapid control of hemorrhage and decreased risk of personal contamination J Trauma 1993 34 Mayrose JM Jehle DV Moscati R Comparison of staples versus sutures in the repair of penetrating cardíac wounds J Trauma 1999 46 Stassen NA Lukan JK Spain DA Reevaluation of diagnostic procedures for transmediastinal gunshot wounds J Trauma 2002 53 4 Aaland MO Sherman RT Delayed pericardial tamponade in penetrating chest trauma: case report J. 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S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100008 Fibroma cardíaco en un neonato Gutiérrez A Rafael Obando V Aiza Arguello C Leslie Mora B Gerardo P Arguello Ana ,C.C.S.S Hospital Nacional de Niños San José Costa Rica ,C.C.S.S San José Costa Rica ,C.C.S.S Hospital Nacional de Niños Carlos Saenz Herrera San José Costa Rica ,C.C.S.S Hospital Nacional de Niños Carlos Saenz Herrera San José ,C.C.S.S Hospital Nacional de Niños Carlos Saenz Herrera San José Costa Rica 01 2005 2005 7 47 49

Niño con 26 días de edad al ingreso, presentó cianosis y dificultad respiratoria progresiva desde el nacimiento, se diagnosticó por ecocardiografía un tumor intracardíaco de la pared libre ventricular izquierda con derrame pericárdico leve. Durante la cirugía se encontró un tumor no resecable. El examen histológico lo clasificó como fibroma. La mortalidad por fibromas cardíacos grandes es alta, un diagnóstico temprano y una extirpación del tumor es mandatoria para aliviar la sintomatología y las consecuencias fatales, existen múltiples abordajes quirúrgicos para niños con fibromas cardíacos que van desde tomar la biopsia y esperar, hasta la resección parcial, total o incluso el trasplante cardíaco.

A 26 days old baby was admitted with cyanosis and respiratory difficulty from birth. An echocardiogram demonstrated an intracardiac tumor originating from the free wall of the left ventricle and mild pericardial effusion. He underwent surgery but the tumor was found to be unresectable, nevertheless he did fine after surgery and was discharged. The pathological diagnosis was cardiac fibroma. The mortality for large cardiac fibroma is high, an early diagnosis and tumor resection is mandatory to relieve the symptoms and to avoid fatal consequences. There are multiple surgical approaches for this entity that range from taking a biopsy to tumor resection, either total or partial or even cardiac transplantation.

 tumor cardíaco fibroma cirugía Cardiac tumor fibrome surgery Isaacs H Fetal and Neonatal Cardíac Tumors Pediatr Cardiol 2004 25 Marelli Roberto Drago Adolfo Basso Gabriel Bravo Florencia Torrijos Roberto Gerones Carlos Tumores cardíacos primarios: aspectos clínicos y tratamiento Rev Fed Arg Cardiol 2002 31 Jiunn-Ren Wu Chaw-Chi Chiu Young-Tso Lin Zen-Kong Hsiang-Ju Lin Cyanosis caused by a huge obstructive right ventricular fibroma Jpn Heart J 2000 41 Burke AP Rosado-de Christensen M Templeton PA Virmani R Cardiac fibroma: clinicopathologic correlates and surgical treatment J Thorac Cardiovasc Surg 1994 108 Beghetti M Gow RM Haney I Mawson J Williams WG Freedom RM Pediatric primary benign cardiac tumors: a 15-year review Am Heart J 1997 134 Parmley LF Salley RK Williams JP Head BG The clinical spectrum of cardíac fibroma with diagnosis and surgical considerations: noninvasive imaging enhances management Ann Thorac Surg 1988 45 Kim T.H Kim Y.M Han M.Y Kim W.-H Oh M.-H K.S Han Perinatal Sonographic Diagnosis of Cardiac Fibroma with MR Imaging Correlation Am. J. Roentgenol Marc h 1, 178 3 Mary L Grebenc Rosado de Christenson Melissa L Burke Allen P Green Curtis E R Jeffrey Galvin Primary Cardíac and Pericardial Neoplasms with Echocardiographic Correlation Radiographics 2000 20 Coffin CM Congenital cardiac fibroma associated with Gorlin syndrome Pediatr Pathol 1992 12
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100009 Puente miocárdico con fenómeno de "ordeñamiento" coronario como causa de angina inestable Lanzas Rodríguez Róger A Acuña Jorge Fernández Magaña Aguilar Alejandro A , 01 2005 2005 7 51 54

Los puentes miocárdicos están constituidos por haces de fibras musculares que recubren un trayecto variable de una arteria coronaria epicárdica, cursando en muchos casos de manera asintomático u originan síntomas debido a síndromes isquémicos coronarios agudos. Su diagnóstico se realiza in-vivo por estudio angiográfico, al comprobarse una compresión sistólica de una arteria coronaria que desaparece durante la sistole, fenómeno denominado de Milking u "ordeñamiento". Se presenta un caso de Puente Miocárdico con fenómeno de ordeñamiento, que ingresó al Servicio de Cardiología del Hospital Dr. Tony Facio Castro de Limón, con diagnóstico de síndrome coronario agudo. Dada la evolución tan variada desde el punto de vista electrocardiográfico, se refirió a coronariografía urgente al Hospital Nacional de Referencia Dr. Rafael A. Calderón Guardia en San José, encontrándose datos angiográficos de puente miocárdico con obstrucción dinámica en sístole (fenómeno de ordeñamiento) de la arteria descendente anterior como causa del síndrome isquémico Agudo. Se considera que dicha patología debe tenerse en cuenta en los síndromes coronarios agudos, sobretodo cuando sus manifestaciones electrocardiográficas son muy variantes como en el presente caso, resaltando la importancia de la coronariografía selectiva bilateral para su diagnóstico y tratamiento.

Myocardial bridges are actually bundles of muscle fibers that cover the path of an epicardial coronary artery for a variable length. Having the patient no symptoms or presenting with an acute coronary syndrome. A coronary angiogram will demonstrate systolic compression of an epicardial artery, which disappears during diastole. This is commonly named "milking phenomenon". We hereby present the case of a male with an acute coronary syndrome who was first seen at the Tony Facio Hospital in Limon. Given his variable EKG changes he was referred to the Calderon Guardia Hospital for coronary angiogram. This exam did show dynamic systolic compression of the left anterior descending coronary artery as a cause of his angina. We believe that this entity should be kept in mind particularly in patients with an acute presentation and variable electrocardiographic findings. A coronary angiogram is of paramount importance to make the diagnosis to establish an adequate treatment.

 Puente Miocárdico Fenómeno de ordenamiento Cardiopatía Isquémica Puente Miocárdico Fenómeno de ordeñamiento Cardiopatía Isquémica Bourassa MG Butnaru A Lespérance J Tardif JC J Am Coll Cardiol 2003 41 Frank RE Myocardial Bridging J Insur Med 1999 31 1 Montenegro F Cisneros M Puentes musculares: Relación de los porcentajes de acortamiento segmentarios y respuesta al tratamiento Rev. Fed Arg Cardiol 2003 32 Arnau-Vives MA Martinez-Dolz LV Almenar-Bonet L Lalaguna LA Ten-Morro F Palencia-Perez M Puentes miocárdicos como una causa de isquemia aguda. Descripción de un caso y revisión de la literatura Rev Esp Cardiol 1999 J un 52 Hongo Y Tada H Ito K Yasumura Y Miyatake K Yamagishi M Augmentation of vessel squeezing at coronary-myocardial bridge by nitroglycerin: study by quantitative coronary angiography and intravascular ultrasound Am Heart J 1999 A ug 138 Bayes A Marti V Auge JM Coronary stenting for symptomatic myocardial bridging Heart 1998 J ul 80 Heinrich G Klues HG Schwarz ER vom Dahl J Reffelmann T Reul H Potthast K Schmitz C Minartz J Krebs W Hanrath P Disturbed intracoronary hemodynamics in myocardial bridging: early normalization by intracoronary stent placement Circulation 1997 N ov 96 De Zwaan C Wellens HJJ Left ventricular aneurysm subsequent to cleavage of myocardial bridging of a coronary artery J Am Coll Cardiol 1984 3 Harikrishnan S Sunder KR Tharakan J Titus T Bhat A Sivasankaran S Bimal F Clinical and angiographic profile and follow-up of myocardial bridges: study of 21 cases Indian Heart J 1999 S ep 51
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100010 Síndrome de QT largo congénito Gutiérrez Sotelo Oswaldo ,C. C. S. S. Hospital México San José Costa Rica 01 2005 2005 7 55 57

Se presenta un caso de síndrome de QT largo congénito que debutó con muerte súbita durante el período del puerperio.

We present a congenital long-QT clinical case, whose first event was aborted suden death during her postpartum period.

 Escobar C Echarri R Amador A Tarancón B Salido L Barrios V Sindrome de QT largo congénito: revisión de las diferentes variantes y tratamientos Rev Costarr Cardiol 2005 7 1 Schwartz PJ Priori SG Spazzolini C for the international long-QT syndrome registry research group. Genotype-Phenotype Correlation in the Long-QT Síndrome: Gene-Specific Triggers for Life-Threatening Arrhythmias Circulation 2001 103 Zareba W Moss Al Schwartz PJ for the international long-QT syndrome registry research group: Influence of the genotype on the clinical course of the long-QT síndrome N Engl J Med 1998 339 Locati EH Zareba W Moss AJ Age and Sex-Related Differences in Clinical Manifestations in Patients with Congenital Long-QT Syndrome Circulation 1998 97 Rashba EJ Zareba W Moss Al for the LQTS Investigators. Influence of Pregnancy in the Risk for Cardiac Events in Patients with Hereditory Long-QT Syndrome Circulation 1998 97 Zang L Timothy KW Vincent GM Spectrum of ST-T-wave patterns and repolarization identify genotipes Circulation 2000 102
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100011 Fiebre reumática, Consenso Nacional 2005 Mas Romero Carlos Faerron Ángel Jorge Castro Bermúdez Abdón Gutiérrez Álvarez Rafael Yong Piñar Bernal ,C. C. S. S. Hospital Nacional de Niños Dr. Carlos Sáenz Herrera San José Costa Rica 01 2005 2005 7 59 62 Joint WHO/ISFC meeting on RF/RHD control with emphasis on primary prevention, Geneva, 7-9 September 1994 Joint WHO/ISFC meeting on RF/RHD control with emphasis on primary prevention, Geneva, 7-9 September 1994 1994 World Health Organization Arguedas A Mohs E Prevention of rheumatic fever in Costa Rica J Pediatr 1992 4 World Health Report: Conquering suffering, enriching humanity, Geneve, World Health Organization World Health Report: Conquering suffering, enriching humanity, Geneve, World Health Organization 1997 Olivier C Rheumatic fever - is it still a problem? J Antimicr Chemother 2000 45 Binotto MA Guilherme L Tanaka AC Rheumatic Fever Images Paediatr Cardiol 2002 11 Cotran RS Kumar V Collins T Rheumatic fever: Robbins Pathologic Basis of Disease Rheumatic fever: Robbins Pathologic Basis of Disease 1999 Sexta WB Saunders Co Guidelines for the Diagnosis of Rheumatic Fever, Jones Criteria, 1992 Update: Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association JAMA 1992 268 Dajani A Taubert K Ferrieri P Peter G Shulman S Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association Pediatrics 1995 96 Herdy GV Pinto CA Olivaes MC Carvalho EA Tchou H Cosendey R Rheumatic carditis treated with high doses of pulsetherapy methylprednisolone: Results in 70 children over 12 years Arq Bras Cardiol 1999 72
S1409-414220050001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000100012 Electrocardiograma del Mes Araya Gómez Vivien ,Centro Cardiológico Integral 01 2005 2005 7 63 64