S1409-414220050002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000200001 Nuestro mayor tesoro… Speranza Sánchez Mario , 05 2005 2005 7 3 3
S1409-414220050002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000200002 Predictores de obstrucción dinámica del tracto de salida del ventrículo izquierdo durante eco estrés dobutamina. Villarroel Abrego Hugo ,Universidad Salvadoreña Nueva San Salvador El Salvador 05 2005 2005 7 7 11

Se estudiaron 60 pacientes adultos de ambos sexos,referidos entre julio del año 2001 y febrero del año 2005 para ecocardiografía de estrés con dobutamina. Objetivos: 1)Definir el valor de diversas variables en la predicción de obstrucción dinámica del tracto de salida del ventrículo izquierdo (gradiente transaórtico máximo con estrés mayor de 30 mmHg)inducida por el uso protocolizado de dobutamina intravenosa durante ecocardiografía de estrés: edad,sexo,historia de hipertensión arterial,hipertrofia concéntrica ventricular izquierda,grosor parietal relativo, diámetro del tracto de salida del ventrículo izquierdo, presencia de septum basal sigmoideo y gradientes transvalvulares aórticos máximos en reposo; 2)Correlacionar hipotensión y dolor toráccico tipo anginoso con obstrucción dinámica ventricular. Resultados:Hubo predominio de sexo femenino en la muestra final.El Grupo A,sin obstrucción dinámica (53.3%)se comparó contra el Grupo B (de aquellos que sí la presentaron,46.7%). No hubo diferencias en cuanto a edad e historia previa de hipertensión arterial.De las demás variables solo el sexo masculino y la presencia de septum basal de configuración sigmoidea tuvieron valor pronóstico para predecir obstrucción dinámica ventricular durante ecocardiografía de estrés con dobutamina.No hubo diferencias significativas entre las medias de ambos grupos en cuanto al calibre del tracto de salida del ventrículo izquierdo ni en los gradientes máximos transaórticos en reposo.Conclusiones:Los ecocardiografistas que trabajan con estrés-dobutamina pueden tomar medidas de precaución en sujetos a riesgo,en especial varones con septum sigmoideo,para limitar riesgos e incomodidades derivadas de una complicación relativamente frecuente.

Sixty adults were referred from july 2000 to february 2005 to be studied with dobutamine echo. Objectives: 1)To determine the predictive value of several parameters of dynamic left ventricular outflow tract (LVOT)obstruction (maximal trans-aortic gradient higher than 30 torr with stress)induced by i.v.dobutamine administered under a protocol The following parameters were investigated:age, gender,history of arterial hypertension,left ventricular concentric hypertrophy,relative parietal thickness,left ventricular outflow tract diameter,presence of sigmoid basal septum and resting transvalvular maximal aortic gradients. 2-To relate hypotension and anginal chest pain with dynamic ventricular obstruction. Results: There was female predominance.Fifty three percent of the patients had no dynamic obstruction (group A ),and 46.7 (group B)did have it.There were no differences regarding age or previous hypertension history.Only masculine gender and sigmoid shaped basal septum had prognostic value to predict ventricular dynamic obstruction during dobutamine stress echocardiography.There were no statistically significant differences between the 2 groups regarding LVOT calibre,nor in resting maximal trans-aortic gradients.Conclusions:echocardiographers working with stress dobutamine echo should take precautions in patients at risk,especially men with sigmoid septum,in order to limit the risks of a relatively frequent complication.

 Ecocardiografía de estrés dobutamina obstrucción dinámica del tracto de salida dobutamine stress echocardiography dynamic outflow tract obstruction Guideline Update for the Clinical Application of Echocardiography: summary article.A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography) J Am Soc Echocardiogr 2003 20 03 16 10 Secknus MA Maewick TH Evolution of dobutamine echocardiography protocols and indications: safety and side effects in 3011 studies over 5 years J Am Coll Cardiol 1997 M ay 29 6 Dionisopoulos PN Collins JD Smart SC The value of dobutamine stress echocardiography for the detection of coronary artery disease in women J Am Soc Echocardiogr 1997 10 8 Mathias W Arruda A Dantos F Safety of Dobutamine-Atropine Stress Echocardiography: a Prospective Experience of 4033 Consecutive studies J Am Soc Echocardiogr 1999 12 Scandura S Arcidiacono S Felis S Dynamic obstruction of left ventricular outflow during dobutamine stress echocardiography:the probable mechanismos and clinical implications Cardiologia 1998 N ov 43 11 Bolca O Dagdeviren B Eren M Evaluation of dynamic left ventricular outflow tract obstruction by dobutamine stress echocardiography Anadolu Kardiyol Derg 2001 S ep 1 3 Luria D Klutstein MW Rosenmann D Prevalence and significance of left ventricular outflow gradient during dobutamine echocardiography Eur Heart J 1999 M ar 20 5 Sonoda M Takenaka K Watanabe F Dobutamine stress causes left ventricular outflow obstruction J Cardiol 1996 27 ^sSuppl 2 Heinle SK Tice FD Kisslo J Hypotension during dobutamine stress echocardiography: is it related to dynamic intraventricular obstruction? Am Heart J 1995 A ug 130 2 Scandura S Felis S Barbagallo G Significance of hypotension and vasovagal reflex during echo.stress using high doses of dobutamine Cardiologia 1997 M ar 42 3 Conklin HM Huang X Davies CH Biphasic left ventricular outflow and its mechanism in hypertrophic obstructive cardiomyopathy Am Soc Echocardiogr 2004 A pr 17 4 Abdullah EE Pollickl C Symptomatic and hemodynamic recovery following dobutamine stress echo: benefit of low-dose esmolol administration Int J Card Imaging 1997 F eb 13 1 Villareal RP Achari A Wilanski S Anteroapical stunning and left ventricular outflow tract obstruction Mayo Clin Proc 2001 J an 76 1 Yalcin F Muderrisoglu H Korkmaz ME The effect of dobutamine stress on left ventricular outflow tract gradients in hypertensive patients with basal septal hypertrophy Angiology 2004 M ay 55 3 Lever HM Karam RF Currie PJ Hypertrophyc Cardiomyopathy in the Elderly: Distinctions from the Young Based on Cardiac Shape Circulation 1989 79 3 Dawn B Paliwal VS Raza ST Left ventricular outflow tract obstruction provoked during dobutamine stress echocardiography predicts future chest pain,syncope,and near syncope Am Heart J 2005 M ay 149 5 Henein MY O ´Sullivan C Sutton GC Stress-induced left ventricular outflow tract obstruction: a potential cause of dyspnea in the elderly J Am Coo Cardiol 1997 N ov 30 5 Cabrera F Rodríguez I López R Obstrucción dinámica intraventricular izquierda inducida por esfuerzo Rev Esp Cardiol 2004 57 12 Hashimoto Y Reid CL Gardin JM Left ventricular cavitary geometry and dynamic intracavitary left ventricular obstruction during dobutamine stress echocardiography Am J Card Imaging 1996 J ul 10 3 Yalcin F Muderrisoglu H Korkmaz ME The effect of dobutamine stress on left ventricular outflow tract gradients in hypertensive patients with basal septal hypertrophy Angiology 2004 M ay 55 3
S1409-414220050002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000200003 Células Madre en la reparación de tejido miocárdico: Biología y Clínica. Zeledón S Fernando Morales Orlando Méndez J Edgar Porras Abigail Zamora L José Orlich Priscilla ,Universidad de Ciencias Médicas San José Costa Rica ,Universidad de Ciencias Médicas San José C.R ,Universidad de Ciencias Médicas San José Costa Rica ,Universidad de Ciencias Médicas San José Costa Rica ,Hospital México San José Costa Rica ,Hospital San Juan de Dios San José Costa Rica 05 2005 2005 7 13 20

En los últimos años se ha visto como las células madre han pasado de ser un concepto de interés científico,a ocupar tantas páginas en las revistas científicas como esperanzados comentarios en la prensa.Los conocimientos que en este campo de la medicina se vienen produciendo de forma casi diaria han disparado las expectativas de los enfermos y de los médicos de que las células madre vayan a contribuir a la curación de múltiples enfermedades humanas como la diabetes,la enfermedad de Parkinson,el infarto de miocardio u otras muchas.En el centro del debate científico,político y ético se ha situado la utilización e investigación con células madre embrionarias.No obstante,ante el descubrimiento de células madre adultas,ya sean del propio enfermo o de un donador, pareciera que existen menos obstáculos en el campo ético,más grados de libertad para el investigador y ciertamente mayores esperanzas para los enfermos.Es por esta razón,que vamos a comentar algunos de los aspectos básicos sobre este tema,en especial,en el interés que ha provocado la terapia con células madre en la reparación de corazones lesionados.

In spite of the controversies involving stem cells,their future utilization has raised enormous expectations.Be as a therapeutic maneuver for degenerative disorders up until now of incurable nature,such as Parkinson ’s disease,muscular dystrophies,diabetes and cardiac diseases,or as a vehicle of genetic therapy,the truth is that we have only started to imagine their therapeutic possibilities. Unfortunately this wide field,has opened more questions than answers.Which is the ideal source for stem cells?Would the different stem cell types cause a beneficial effect in different situations.How many cells should be transplanted?Which is the most advisable access?Is it better to perform cell therapy during the acute phase of a myocardial infarction, or during the chronic phase?What type of stem cells should be transplanted?What mechanisms govern stem cells to survive and to differentiate?What is the average life of the new myocites?How safe is the procedure?Is there a role for pharmaceuticals in conjunction with stem cell therapy?And so on. We have to keep in mind that to make stem cell therapy a reality,is absolutely necessary to continue rigorous basic research,since the ultimate use of this approach in the management of myocardial infarction in the acute or chronic phase of an MI should be based in solid scientific principles and randomized studies that can assure more benefits than side effects.

 Forrester JS Price MJ Makkar RR Stem cell repair of Infarcted Myocardium: an overview for clinicians Circulation 2003 108 Weissman IL Anderson DJ Gage F Stem and progenitor cells: origins, phenotypes,lineage commitments,and transdifferentiations Annu Rev Cell Dev Biol 2001 17 Jiang Y Vaessen B Lenvik T Blackstad M Reyes M Verfaillie CM Multipotent progenitor cells can be isolated from postnatal murine bone marrow,muscle,and brain Exp Hematol 2002 30 Grant MB May WS Caballero S Brown GA Guthrie SM Mames RN Adult hematopoietic stem cells provide functional hemangioblast activity during retinal neovascularization Nat Med 2002 8 Korbling M Estrov Zeev Adult Stem Cell for Tissue Repair: a new therapeutic concept? N Engl.J Med 2003 349 Pittenger MF Mackay AM Beck SC Jaiswal RK Douglas R Mosca JD Multilineage potential of adult human mesenchymal stem cells Science 1999 284 Asakura A Seale P Girgis-Gabardo A Rudnicki MA Myogenic specification of side population cells in skeletal muscle J Cell Biol 2002 159 Jiang Y Jahagirdar BN Reinhardt RL Schwartz RE Keene CD Ortiz- Gonzalez XR Pluripotency of mesenchymal stem cells derived from adult marrow Nature 2002 418 Hao QL Thiemann FT Smogorzewska EM Crooks GM Extended long-term culture reversals a highly quiescent and primitive human hematopoietic progenitor population Blood 1996 88 Hao QL Shah AJ Thiemann FT A functional comparison of CD34+ CD38 cells in cord blood and bone marrow Blood 1995 86 Lagasse E Connors H Al-Dhalimy M Reitsma M Dohse M Osborne L Purified hematopoietic stem cells can differentiate into hepatocytes in vivo Nat Med 2000 6 Orlic D Kajstura J Chimenti S Jakoniuk I Anderson SM Li B Bone marrow cells regenerate infarcted myocardium Nature 2001 410 Krause DS Theise ND Collector MI Henegariu O Hwang S Gardner R Multi-organ,multi-lineage engraftment by a single bone marrow-derived stem cell Cell 2001 105 Terada N Hamazaki T Oka M Hoki M Mastalerz DM Nakano Y Bone marrow cells adopt the phenotype of other cells by spontaneous cell fusion Nature 2002 416 Ying QL Nichols J Evans EP Smith AG Changing potency by spontaneous fusion Nature 2002 416 Wang X Willenbring H Akkari Y Torimaru Y Foster M Al-Dhalimy M Cell fusion is the principal source of bone-marrow-derived hepatocytes Nature 2003 422 Wagers AJ Sherwood RI Christensen JL Weissman IL Little evidence for developmental plasticity of adult hematopoietic stem cells Science 2002 297 Orlic D Hill J Arai AE Stem Cell for Myocardial Regeneration Circ.Res 2002 91 Graf T Differentiation plasticity of Hematopoietic cells Blood 2002 99 Anversa P Sussman M Bolli R Molecular Genetic Advances in Cardiovascular Medicine: Focus on the Myocyte Circulation 2004 109 Laflamme MA Myerson D Saffitz JE Murry CE Evidence for cardiomyocyte repopulation by extra cardíac progenitors in transplanted human hearts Circ Res 2002 90 Wang JS Shum-Tim D Chedrawy E The coronary delivery ofmarrow stromal cells for myocardial regeneration: pathophysiologic and therapeutic implications J Thorac Cardiovasc Surg 2001 122 Strauer BE Brehm M Zeus T Repair of infarcted myocardium byautologus intracoronary mononuclear bone marrow cell transplantation in humans Circulation 2002 106 Perin EC Geng YJ Willerson JT Adult Stem Cell Therapy in Perspective Circulation 2003 107 Shake JG Gruber PJ Baumgartner WA Mesenchymal stem cell implantation in a swine myocardial infarct model: engraftment and functional effects Ann Thorac Surg 2002 73 Zhang YM Hartzell C Narlow M Dudley S Stem Cell-Derived Cardiomyocytes Demonstrate Arrhythmic Potential Circulation 2002 106 Yoon YS Seon J Unexpected Severe Calcification After Transplantation of Bone Marrow Cells in Acute Myocardial Infarction Circulation 2004 109 Chien KR Lost in translation Nature 2004 428 Mummery C Solace for the broken hearted? Nature 2004 433 Mathur A Martin JF Stem cells and repair of the heart Lancet 2004 364 Lovel-Badge R The future for stem cell researche Nature 2001 414 Szmitko PE Fedak PW Weisel RD Stewart DJ Endothelial Progenitor Cells:New Hope for the Broken Heart Circulation 2003 107
S1409-414220050002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000200004 Mixoma de la válvula mitral en un niño.Presentación de un caso y revisión de la literatura. Gutiérrez A Rafael Faerron A Jorge Arguello C Leslie Obando V Aiza Vargas S Mauricio Suárez Z Adrián ,C.C.S.S San José Costa Rica ,C.C.S.S San José Costa Rica ,C.C.S.S San José Costa Rica ,C.C.S.S San José Costa Rica ,C.C.S.S San José Costa Rica ,C.C.S.S San José Costa Rica 05 2005 2005 7 21 23

Niño de 11 años de edad con historia de dolor torácico intermitente de 6 meses de evolución y soplo cardíaco.El ecocardiograma mostró una masa tumoral en la válvula mitral con insuficiencia valvular moderada.Se intervino quirúrgicamente con resección extensa del tumor de la válvula mitral y de los músculos papilares al cual estaba adherido,se colocó una válvula mitral protésica.El diagnóstico patológico fue de mixoma de la válvula mitral.Este tumor es raro en la infancia,con una localización pocas veces descrita,de carácter benigno,pero potencialmente fatal.

An 11 year old boy came in with a 6 months history of intermittent chest pain and a cardiac murmur.An echocardiogram showed a mitral valve mass and mild insufficiency.He underwent an extensive resection of the mitral valve and its papillary muscles,since it was attached to them.A prosthetic mitral valve was implanted.The pathological report was mitral valve myxoma.This type of tumor is unusual during infancy,its location is seldom described,although benign in nature it is potentially fatal.

 Tumores cardíacos mixoma de la válvula mitral cirugía Freedom RM Lee KJ Mac Donald C Taylor G Select aspects of cardiac tumors in infancy and childhood Pediatr Cardiol 2000 21 Isaacs H Fetal and Neonatal Cardiac Tumors Pediatric Cardiol 2004 25 Almage C Revillen L Michardiere A Myxoma of the mitral valve in a child. Apropos of an operate case Arch Mal Coeur Vaiss May 19 80 73 5 Reiner K Cardiac Myxoma,review article N Engl J Med 1995 333 Kirklin JW Barrat-Boyes BG Cardiac Surgery Cardiac Surgery 1993 2 2 ^eNew York Churchill Livinstone Michael Yu-Chih Ji Hung Wang Shen-Feng Chao Cardiac Myxoma from the Anterior Mitral Leftlet Jpn Heart J May 20 03 44 3 Santibanez F Attié F Vargas J Ramírez Samuel Mixoma Interventricular Izquierdo Arch Cardiol Mex Oct 20 04 74 4 Salle D Spector ML van Heeckeren DW Patel CR Primary pediatric cardiac tumors: a 17 year experience Cardiol Young 1999 2 Aguy M Reyer M Cobanoglu A Tricuspid Valve in a Pediatric Patient: 10-Year Follow-Up Alter Resection Ann Thorac Surg 1999 67
S1409-414220050002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000200005 Consenso costarricense para el manejo de la fibrilación atrial. Gutiérrez Sotelo Oswaldo Araya Gómez Vivien Faerron Angel Enrique ,C.C.S.S ,C.C.S.S ,C.C.S.S 05 2005 2005 7 25 29
S1409-414220050002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422005000200006 Electrocardiograma del Mes. Araya Gómez Vivien ,Centro Cardiológico Integral 05 2005 2005 7 30 30