S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100001 A propósito de cardiopatías congénitas Salazar Vargas Dr. Carlos ,Hospital Rafael A. Calderón Guardia San José Costa Rica 01 2007 2007 9 3 4
S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100002 III Congreso Nacional de Cardiología, 2-4 Mayo del 2007, Hotel Corobicí, San José, Costa Rica , 01 2007 2007 9 5 6
S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100003 Cardiopatías Congénitas en Costa Rica: análisis de 9 años de registro Benavides Lara Dra. Adriana Umaña Solís Dra. Lila ,Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA) Tres Ríos Cartago Costa Rica ,Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA) 01 2007 2007 9 9 14

Introducción: Las cardiopatías congénitas (CC) se encuentran entre las malformaciones congénitas más comunes y tienen gran impacto en la morbilidad y mortalidad pediátricas. El objetivo del presente estudio es explorar la prevalencia y tendencias de las CC en Costa Rica en el período de 1996 al 2004. Materiales y métodos. El presente es un estudio retrospectivo de base poblacional de los datos del Registro Nacional de Malformaciones Congénitas, anotando variables como año de registro de la CC, tipo, sexo, edad materna y distribución geográfica. Se realizó además un análisis de su impacto en la mortalidad infantil a partir de datos del Instituto Nacional de Estadística y Censos. Resultados: De todas las malformaciones congénitas las cardiopatías son las más letales y su prevalencia dentro del tiempo estudiado mostró un aumento de 0,10% a 0,18%. Son más frecuentes en varones (p=NS) y la edad materna no demostró ser un factor de riesgo para presentarla. Las CC más frecuentes son los defectos del tabique interventricular. San José y Limón fueron las provincias con mayor prevalencia y Guanacaste con la menor. Conclusiones: Las CC son las malformaciones más frecuentes y son causa importante de muerte infantil en Costa Rica. Deben mejorarse su diagnóstico perinatal y su registro, con el objetivo de dictar políticas de prevención y atención.

Introduction: Congenital cardiovascular anomalies constitute one of the largest groups among severe congenital defects and exert an important impact over mortality. This study explored the prevalence and tendencies of congenital cardiovascular defects in Costa Rica between the years of 1996 and 2004. Methods: A retrospective population based investigation was undertaken from data of the National Registry of Congenital Malformations, taking into account the following factors: type of cardiac anomaly, maternal age, year of registry and geographic distribution of the patients at birth. Besides, we analyzed the impact of a congenital cardiac defect over infant mortality. Results: The prevalence of congenital heart defects increased from 0,1% to 0,18% during the study period. They exerted greatest impact over infant mortality when compared with any other group of congenital malformations. They show higher frequency in males (p>0.1) and maternal age did not constitute a significant risk factor. The most common lesion detected was ventricular septal defect, finding that agrees with that of other studies from around the world. San José and Limón were the provinces with the highest rates of occurrence and Guanacaste showed the lowest one. Conclusions: In Costa Rica congenital heart defects have become the malformation with the greatest impact upon infant mortality. This finding represents an important challenge to improve their perinatal diagnosis and their registry with the aim of implementing prevention policies.

 Cardiopatías congénitas malformaciones congénitas mortalidad infantil Ventricular septal defect isolated muscular perimembranous septal aneurysm Boneva R Botto L Moore C Yang Q Correa A Erickson D Mortality associated with congenital heart defects en the United States: trends and racial disparities, 1979-1997 Circulation 2001 103 Wren C Richmond S Donalson L Temporal variability in birth prevalence of cardiovascular malformations Heart 2000 83 Memberg A Otterstad JE Froland G Hals J Sorland SJ Early clinical screening of neonates for congenital heart defects: the cases we miss Cardiology in the Young 1999 9 Bosi G Scorrano M Tosato G Forini E Chakrokh R The Italian Multicentric Study on Epidemiology of Congenital Herat disease: first step of the analysis. Working party of the Italian Society of Pediatric Cardiology Cardiology in the Young 1999 9 3 Dastgiri S Stone DH Le-Ha C Gilmour WHl Prevalence and secular trend of congenital anomalies en Glasgow,UK Archives of Disease Childhood 2002 86 Baekgard Laursen Some epidemiological aspects of congenital Heart disease in Denmark Acta Paediatric Scandinavian 1980 69 Hoffman JI Kaplan S The incidence of congenital heart disease Journal of American College of Cardiology 2002 39 12 Instituto Nacional de Estadística y Censos de Costa Rica, INEC Instituto Nacional de Estadística y Censos de Costa Rica, INEC Brennan P Young ID Congenital heart malformations: aetiology and associations Seminars in Neonatology 2001 6 Kuehl K Loffredo C Ferencz Ch Failure to diagnose congenital heart disease in infancy Pediatrics 1999 103 McMillan J DeAngelis C Feigin R Warshaw J Oski ’s Pediatrics: Principles and practice Oski ’s Pediatrics: Principles and practice 1999 Third Edition Philadelphia Lippincott Williams and Wilkins Pradat P Francannet C Harris JA Robert E The Epidemiology of Cardiovascular Defects, Part 1: a study based on data from three large registries of congenital malformations Pediatr Cardiol 2003 24 Harris JA Francannet C Pradat P Robert E The Epidemiology of Cardiovascular Defects, Part 2: a study based on data from three large registries of congenital malformations Pediatr Cardiol 2003 24 Carlgren LE Ericson A Kallen B Monitoring of congenital cardiac defects Pediatr Cardiol 1987 8 Hanna EJ Nevin NC Nelson J Genetic study of congenital heart defects in Northern Ireland 1974-1978 J Med Genet 1994 31 Hoffman JIE Anderson RH Macartney FJ Shineborne Incidence, mortality and natural history Pediatric Cardiology Pediatric Cardiology 2002 ^eLondon Churchil Livingstone Dastgiri S Gilmour WH Stone DH Survival of children born with congenital anomalies Arch Dis Child 2003 88 Samanek M Voriskova M Congenital heart diseases among 815569 children born between 1980 and 1990 and their 15 year survival: a prospective Bohemia survival study Pediatric Cardiology 1999 20 Ferencz C Correa-Villaseñor A Loffredo CA Wilson PD Genetics and enviromental risk factors of major cardiovascular malformations: The Baltimore-Washington Infant Study: 1981-1989 Perspectives in Pediatric Cardiology Perspectives in Pediatric Cardiology 1997 Vol. 5 Armonk^eNY Futura Publishing Bosi G Garani G Scorrano M Calzolari E Temporal variability in birth prevalence of congenital heart defects as recorded by a general birth defects registry J Pediatr 2003 142 Pexieder T Bhoch D Clark EB Markwald RR Takao A EUROCAT Subproject on epidemiology of congenital heart diseases: first analisys of the completed study Developmental mechanism of heart disease Developmental mechanism of heart disease 1995 Armonk^eNY Futura Publishing Co Tennstedt C Chaoui R Corner H Dietel M Spectrum of congenital heart defects and extracardiac malformations associated with chromosomal abnormalities: results of seven year necropsy study Heart 1999 82 11 Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados de Salud Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados de Salud 1995 Volumen 1 ^eWashington DC OPS
S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100004 Infarto Agudo de Miocardio: Certezas e Incertidumbres con las Nuevas Estrategias de Reperfusión Iglesias Dr. Ricardo Mario Lescano Dr. Adrian ,Fellow American College of Cardiology Buenos Aires Argentina ,Sociedad Argentina de Cardiología Argentina 01 2007 2007 9 17 26

Las enfermedades cardiovasculares representan la primera causa de morbimortalidad a nivel mundial. El infarto agudo de miocardio es la expresión más dramática dentro del síndrome coronario agudo y el accidente de placa coronario, el mecanismo fisiopatológico involucrado con mayor frecuencia. El objetivo del tratamiento ha variado en los últimos años, desde obtener permeabilidad en las arterias epicárdicas hasta alcanzar un decuado nivel e perfusión n el ircuito microvascular. La optimización de la estrategia terapéutica se obtiene a través de una reperfusión precoz y efectiva (fibrinolíticos y/o angioplastia) y la selección adecuada de múltiples fármacos coadyuvantes (B bloqueantes, aspirina, clopidogrel, anticoagulantes) que han demostrado beneficios clínicos en diversos ensayos clínicos.

The first cause of morbidity-mortality all over the world is represented by the cardiovascular diseases. The acute infarct of myocardium is the most dramatic expression within the acute coronary syndrome and the coronary plaque rupture, the most frequently physiopathology mechanism involved. In the last few years the objective of the treatment has changed, from obtaining permeability in the epicardial arteries to reaching a suitable level of perfusion in the microvascular circuit. The optimization of the therapeutic strategy obtains through a precocious and effective reperfusion (fibrinolytic and/or angioplasty) and the suitable helping drug selection (aspirin, clopidogrel and anticoagulants) that has demonstrated clinical benefits in clinical trials

 Infarto agudo del miocardio reperfusión fibrinolíticos angioplastía Acute myocardial infartion reperfusion fibrinolitics angioplasty Fuster V Moreno PR Fayad ZA Corti R Badimon JJ Aterotrombosis and high risk plaque: part I: evolving concepts J Am Coll Cardiol 2005 46 Fibrinolytic therapy trialists (FTT)collaborative group.Indications for fybrinolitic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results of all randomized trials of more than 1000 patients Lancet 1994 343 Fox KA Dabbous OH Goldberg RJ Pieper KS Eagle KA Van de Werf F Avezum A Goodman SG Flather MD Anderson FA Granger CB Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE) BMJ 2006 25 Canto JG Taylor HA Jr Rogers WJ Sanderson B Hilbe J Barron HV Presenting characteristics, treatment patterns, and clinical outcomes of non-black minorities in the National Registry of Myocardial Infarction 2 Am J Cardiol 1998 N ov 82 9 Perez de Arenaza D Taneja AK Flather M Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction (PRAGUE-2 trial) Eur Heart J 2003 24 19 Andersen HR Nielsen TT Rasmussen K Thuesen L Kelbaek H Thayssen P Abildgaard U Pedersen F Madsen JK Grande P Villadsen AB Krusell LR Haghfelt T Lomholt P Husted SE Vigholt E Kjaergard HK Mortensen LS DANAMI-2 Investigators. A Comparison of Coronary Angioplasty with Fibrinolytic Therapy in Acute Myocardial Infarction N Engl J Med 2003 349 8 Steg PG Bonnefoy E Chabaud S Lapostolle F Dubien PY Cristofini P Leizorovicz A Touboul P Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial Circulation 2003 108 23 An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO Investigators N Eng J Med 1993 329 A Comparison of Reteplase with Alteplase for Acute Myocardial Infarction. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators N Eng J Med 1997 337 Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Investigators, Van De Werf F, Adgey J, Ardissino D, Armstrong PW, Aylward P, Barbash G, et al. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial Lancet 1999 354 den Heijer P Vermeer F Ambrosioni E Sadowski Z López SS von Essen R Evaluation of a weight-adjusted single-bolus plasminogen activator in patients with myocardial infarction: a double-bblind, randomized angiographic trial of lanoteplase versus alteplase Circulation 1998 98 20 ISIS 2 collaborative group (Second International Study of Infarct Survival). Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group Lancet 1988 2 Marc S Sabatine M.D Christopher P Cannon M.D., C Michael Gibson M.D Jose L López-S M.D Gilles Montalescot M.D Pierre Theroux M.D Marc J Claeys Cools Frank Hill Karen A Skene Allan M McCabe Carolyn H Braunwald Eugene for the CLARITY -TIMI 28 Investigators Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-S Elevation N Eng J Med 2005 352 Chen ZM Jiang LX Chen YP Xie JX Pan HC Peto R Collins R Liu LS COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial Lancet 2005 366 ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. ISIS-3 (Third International Study of Infarct Survival) Collaborative Group Lancet 1992 339 8796 Moccetti T Malacrida R Pasotti E Sessa F Genoni M Barlera S Turazza F Maggioni AP Epidemiologic variables and outcome of 1972 young patients with acute myocardial infarction. Data from the GISSI-2 database. Investigators of the Gruppo Italiano per lo Studio della Sopravvivenza nell ’Infarto Miocardico (GISSI-2) Arch Intern Med 1997 157 8 Antman EM Morrow DA McCabe CH Murphy SA Ruda M Sadowski Z Budaj A Lopez S Guneri S Jiang F White HD Fox KA Braunwald E ExTRACT-TIMI 25 Investigators. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction N Engl J Med 2006 354 14 Yusuf S Mehta SR Xie C Ahmed RJ Xavier D Pais P Zhu J Liu L Effects of reviparin, a low-molecular-weight heparin, on mortality, reinfarction, and strokes in patients with acute myocardial infarction presenting with ST-segment elevation JAMA 2005 293 Yusuf S Mehta SR Chrolavicius S Afzal R Pogue J Granger CB Budaj A Peters RJ Bassand JP Wallentin L Joyner C Fox KA OASIS-6Trial Group. elevation myocardial infarction: the OASIS-6 randomized trial JAMA 2006 295
S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100005 Ultrafiltración como alternativa terapéutica en la insuficiencia cardiaca congestiva Brenes S Dr. Jorge A ,Hospital Calderón Guardia San José Costa Rica 01 2007 2007 9 27 32

La Insuficiencia Cardiaca Congestiva es un síndrome complejo que representa un problema de salud pública. En los casos con excesiva retención de líquidos, los intentos por mantener un estado euvolémico sostenido son en ocasiones insuficientes y su manejo tradicional con diuréticos, tanto de manera aguda como crónica, no ha demostrado incrementar la supervivencia de estos pacientes a largo plazo y de manera paradójica, agrava el círculo vicioso neurohormonal, que es el sustrato fisiopatológico principal de esta entidad. En este contexto, la ultrafiltración surge como alternativa terapéutica capaz de remover cantidades significativas de fluido en este tipo de pacientes, mejorando su capacidad funcional y perfil de peso de manera sostenida, al atenuar la estimulación del eje renina-angiotensina-aldosterona y sistema nervioso simpático. Su tolerancia y perfil de seguridad son adecuados. Futuros estudios analizarán la relación costo/beneficio de esta terapia y su aplicación a mayor escala.

Congestive Heart Failure is a complex syndrome that represents a public health problem. In cases with excessive volume fluid overload,attempts to maintain a sustained euvolemic state are sometimes insufficient and its traditional management with diuretics, both acutely and chronically, has failed to demonstrate increased survival on the long term, and paradoxically, it aggravates the vicious neurohormonal cycle, which is the main pathophysiological feature of this entity. In this context, ultrafiltration comes as a therapeutic alternative, capable of removing significant amounts of fluid in these patients, improving their functional capacity and weight profile in a sustained way, attenuating the stimulation of the renin-angiotensin-aldosterone axis and sympathetic nervous system. Its tolerance and security profile are adecuate. Future studies will address the cost/benefit relationship and its possible application on a larger scale.

 insuficiencia cardiaca eje renina-angiotensina-aldosterona sistema nervioso simpático diuréticos ultrafiltración heart failure renin-angiotensin-aldosterone axis sympathetic nervous system diuretics ultrafiltration Francis G Benedict C Johnstone DE Kirlin PC Nicklas J Liang CS Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without Congestive Heart Failure: a substudy of the Studies of Left Ventricular Dysfunction (SOLVD) Circulation 1990 82 5 Sharma A Hermann D Mehta R Clinical Benefit and Approach of Ultrafiltration in Acute Heart Failure Cardiology 2001 96 Adams K Fonarow G Emerman C LeJemtel T Costanzo MR Abraham W Characteristics and outcomes of patients hospitalized for Heart Failure in the United States: rationale, design, and preliminary observations from the first 100.000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE) Am Heart J 2005 149 2 Costanzo MR Saltzberg M O`Sullivan J Sobotka P Early Ultrafiltration in Patients with Decompensated Heart Failure and Diuretic Resistance (EUPHORIA) J Am Coll Cardiol 2005 46 11 Elkayam U Hatamizadeh P Janmohamed M The Challenge of Correcting Volume Overload in Hospitalized Patients with Decompensated Heart Failure J Am Coll Cardiol 2007 49 6 Bart B Boyle A Bank A Anand I Olivari MT Kraemer M Ultrafiltration Versus Usual Care for Hospitalized Patients with Heart Failure (RAPID) J Am Coll Cardiol 2005 46 11 Cadnapaphornchai M Gurevich A Weinberger H Schrier R Pathophysiology of Sodium and Water retention in Heart Failure Cardiology 2001 96 Guazzi M Agostoni P Perego B Lauri G Salvioni A Giraldi F Apparent paradox of neurohormonal axis inhibition after body fluid volume depletion in patients with Chronic Congestive Heart Failure and water retention Br Heart J 1994 72 Cohn J Levine T Olivari MT Garberg V Lura D Francis GS Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure N Engl J Med 1984 311 Domanski M Norman J Pitt B Haigney M Hanlon S Peyster E Diuretic use, Progressive Heart Failure and Death in Patients in the Studies of Left Ventricular Dysfunction (SOLVD) J Am Coll Cardiol 2003 42 4 Weber K Furosemide in the Long Term Management of Heart Failure: the Good, the Bad and the Uncertain J Am Coll Cardiol 2004 44 6 Gheorghiade M Zannad F Sopko G Klein L Piña I Konstam M Acute Heart Failure Syndromes: current state and framework for future research Circulation 2005 112 Ellison D Diuretic Therapy and Resistance in Congestive Heart Failure Cardiology 2001 96 Executive Summary: HFSA 2006. Comprehensive Heart Failure Practice Guidelines J Card Fail 2006 12 Butler J Forman D Abraham W Gottlieb S Loh E Massie B Relationship between Heart Failure treatment and development of worsening renal function among hospitalized patients Am Heart J 2004 147 2 Francis G Siegel R Goldsmith S Olivari MT Levine B Cohn J Acute Vasoconstrictor Response to Intravenous Furosemide in Patients with Chronic Congestive Heart Failure Ann Intern Med 1985 103 1 Pitt B Zannad F Remme W Cody R Castaigne A Pérez A The Effect of Spironolactone in Morbidity and Mortality in Patients with Severe Heart Failure NEJM 1999 341 10 Pitt B Williams G Remme W Martínez F López-Sendon Zannad F The EPHESUS Trial: Eplerenone in Patients with Heart Failure Due to Systolic Dysfunction Complicating Acute Myocardial Infarction Cardiovascular Drugs and Therapy 2001 15 1 Costanzo M Guglin M Saltzberg M Jessup M Bart B Teerlink J Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure J Am Coll Cardiol 2007 49 6 Ronco C Bellomo R Ricci Z Hemodynamic Response to Fluid Withdrawal in Overhydrated Patients treated with Intermittent Ultrafiltration and Slow Continous Ultrafiltration: role of Blood Volume Monitoring Cardiology 2001 96 Agostoni P Marenzi G Lauri G Perego G Schianni M Sganzerla P Sustained Improvement of Functional Capacity after removal of Body Fluid with Isolated Ultrafiltration in Chronic Cardiac Insufficiency: failure of Furosemide to provide the same result Am J Med 1994 96 Agostoni P Marenzi G Pepi M Doria E Salvionni A Perego G Isolated Ultrafiltration in Moderate Congestive Heart Failure J Am Coll Cardiol 1993 21 2 Marenzi G Grazi S Giraldi F Lauri G Perego G Guazzi M Interrelation of Humoral Factors, Hemodynamics and Fluid and Salt Metabolism in Congestive Heart Failure: effects of Extracorporeal Ultrafiltration Am J Med 1993 94 Jaski B Ha J Denys BG Lamba S Trupp RJ Abraham WT Peripherally inserted veno-venous Ultrafiltration for rapid treatment of volume overloaded patients (SAFE) J Card Fail 2003 9 Davenport A Ultrafiltration in Diuretic-Resistant Volume Overload in Nephrotic Syndrome and Patients with Ascites due to Chronic Liver Disease Cardiology 2001 96
S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100006 Origen anómalo de la arteria coronaria izquierda originándose de la arteria pulmonar. Reporte de caso y revisión de literatura Jiménez Vega José Gutiérrez Álvarez Rafael Madhok Manu Gleason Kelly ,Universidad de Ciencias Médicas Tibás San José Costa Rica ,Hospital Nacional Niños San José Costa Rica ,Children´s Hospitals and Clinics of Minnesota EEUU 01 2007 2007 9 33 37

Se presenta el caso de un lactante de 2 meses de edad que consultó por tos y dificultad respiratoria; al ser admitido en el servicio de urgencias, el abordaje inicial fue de una infección respiratoria baja (bronquiolitis) pero la evolución tórpida y la presencia de cardiomegalia hizo sospechar una cardiopatía, diagnosticándose origen anómalo de la arteria coronaria izquierda que nace de la arteria pulmonar, la cual fue tratada quirúrgicamente con resultado favorable.

2 month old male who was brought to the emergency department with a history of non productive cold, was noticed with difficulty breathing. He was admitted with the possible diagnosis of bronquioloitis. The poor evolution of the patient, and the presence of cardiomegaly, made the physicians look for a cardiopathy, and a diagnosis of anomalous left coronary artery from the pulmonary artery was made. He was stabilized and then was taken to the operating room and had his anomalous coronary artery reimplanted to his aorta

 Dificultad respiratoria cardiomegalia Origen anómalo de la arteria coronaria izquierda Respiratory Distress Cardiomegaly Anomalous Left Coronary Artery Pulmonary Artery Bland EF White PD Garland J Congenital abnormalities of coronary arteries; report of an unusual case associated with cardiac hypertrophy Am J Cardiol 1933 8 Gasul Bm Arcilla RA Lev MJB Heart disease in children. Diagnosis and treatment Heart disease in children. Diagnosis and treatment 1966 ^ePhiladelphia Lippincott Agusstson MH Gasul BM Graetinger JS Bicoff JP Waterman DF Anomalous origin of the left coronary artery from the pulmonary artery. Diagnosis and treatment of infantile and adult type JAMA 1962 15 Case RB Morrow AG Stainsby W Nestor JO Anomalous origin of the left coronary artery Circulation 1958 17 Keith JD Anomalous origin of the left coronary artery from the pulmonary artery Br Heart J 1959 21 Boostein JJ Aberrant left coronary artery Am J. Roentgenol 1964 37 Perloff JK Perloff JK Child J. S The increase and regression of ventricular mass Congenital heart disease in Adults Congenital heart disease in Adults ^ePhiladelphia Takeuchi S Imamura H Katsumoto K New surgical method for repair of anomalous left coronary artery from pulmonary artery J Thorac Cardiovasc Surg 1979 78 Noren GR Raghib G Moller JH Amplatz K Adams P Edwards JE Anomalous origin of the left coronary artery from the pulmonary trunk with special reference to the occurrence of mitral insufficiency Circulation 1964 30 Perry LW Scott LP Anomalous origin of the left coronary artery from the pulmonary artery Circulation 1970 41 Askenazi J Nadas AS Anomalous left coronary artery originating from the pulmonary artery. Report on 15 cases Circulation 1975 51 Burch GE DePasquale NP The anomalous left coronary artery: An experiment of nature Am. J. Med 1964 37 Burchell HB Brown AL Anomalous origin of the left coronary artery from the pulmonary artery masquerading as mitral insufficiency Am Heart J 1962 63 Davachi F Moller JH Edwards JE Disease of the mitral valve in infancy Circulation 1971 43 Usman A Fernandez B Uricchio JF Nichols HT Aberrant origin of the left coronary artery combined with mitral regurgitation in an adult Am. J. Cardiol 1961 8 Sabitson DC Neill CA Taussig HB The direction of blood flow in anomalous left coronary artery arising from the pulmonary artery Circulation 1960 22 Perloff JK Roberts NK Cabeen WR Left axis deviation Circulation 1979 60 Sabitson DC Pelargonio S Taussig HB Myocardial infarction in infancy J. Thorac Cardiovasc. Surg 1960 40 Stein HL Hagstrom JWC Ehlers KH Steinberg I Anomalous origin of the left coronary artery from the pulmonary artery: Angiographic and pathologic study of a case Am J. Roentgenol 1965 93 Perloff JK Roberts WC The mitral apparatus Circulation 1972 46 Flaherty JT Spach MS Boineau JP Canent RV Barr RC Sabiston DC Cardiac potentials on body surface of infants with anomalous origin of the left coronary artery (myocardial infarction) Circulation 1967 36 Canter CE Gutierrez Fr Spray TL Martin TC Diagnosis of anomalous origin of the left coronary artery arising from the pulmonary trunk by color Doppler echocardiography Am Heart J 1988 116 Cronk ES Sinclair JG Rigdon RH An anomalous origin of the left coronary artery arising from the pulmonary artery Am Heart J 1962 64 Houston AB Pollock JCS Doig WB Gnanapragasam J Jameson MPG Lilley S Murtagh EP Anomalous origin of the left coronary artery from the pulmonary trunk: Elucidation with colour Doppler flow mapping Br Heart Jl 1990 63 50 Hirakow R Development of the cardiac blood vessels in staged human embryos Acta Anat 1983 115 Wesselhoeft H Fawcett JS Johnson AL Anomalous origin of the left coronary artery from the pulmonary trunk CirculationAnomalous origin of the left coronary artery from the pulmonary trunk 1968 38 Stein, HL Hagstrom JWC Ehlers KH Steinberg I Anomalous origin of the left coronary artery from the pulmonary artery: Angiographic and pathologic study of a case Am J. Roentgenol 1965 93 Neches WH Mathews RA Park SC Anomalous origino f the left coronary artery from the pulmonary artery: A new method of surgical repair Circulation 1974 50 Dodge-Khatami A Mavroudis C Backer CL Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy Ann Thorac Surg 2002 S ep 74 3 Takeuchi S Imamura H Katsumoto K New surgical method for repair of anomalous left coronary artery from pulmonary artery J Thorac Cardiovasc Surg 1979 78
S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100007 Ablación con radiofrecuencia de fibrilación atrial y taquicardias atriales izquierdas: Reporte de los primeros casos realizados en Costa Rica Araya Gómez Vivien Gutiérrez Sotelo Oswaldo González Mario Abed R Mohammad ,Hospital Clínica Bíblica Clínica de Arritmias y Sala de Electrofisiología San José Costa Rica ,Hospital Clínica Bíblica Clínica de Arritmias y Sala de Electrofisiología San José Costa Rica ,Penn State Heart & Vascular Institute Penn State Milton S. Hershey Medical Center EEUU ,Hospital Clínica Bíblica San José Costa Rica 01 2007 2007 9 39 44

El objetivo de este reporte es presentar los primeros casos de fibrilación atrial que han sido tratados en Costa Rica mediante ablación con radiofrecuencia. Se trata de 3 hombres de 54, 55 y 50 años de edad, el primero con disfunción sinusal y corazón estructuralmente normal, el segundo hipertenso arterial y el tercero portador de miocardiopatía hipertrófica septal asimétrica no obstructiva. Los atrios izquierdos midieron 41, 48 y 47 mm respectivamente. La forma de presentación de la arritmia fue paroxística en los 3 casos, muy repetitiva a pesar de tratamiento médico. Se realizó abordaje del atrio izquierdo en busca de potenciales de venas pulmonares las que indican la presencia de focos ectópicos de activación anormal, sitios en los que se aplicó radiofrecuencia. En 2 pacientes se documentó además flúter atrial común, que fue también eliminado al aplicar radiofrecuencia en el istmo cavo-tricuspídeo. Los pacientes toleraron bien el procedimiento y no hubo complicaciones. Los 3 han permanecido libres de arritmia a 30 días del procedimiento.

We present the first 3 cases of atrial fibrillation treated by radiofrequency ablation in Costa Rica. They were males, 54, 55 and 50 years of age, the first had sinus node dysfunction and a normal structured heart, the second was hypertensive and the third had non-obstructive asymmetric septal hypertrophy. The left atrium measured 41, 48 and 47 mm respectively. Their presentation was one of paroxistic and repetitive arrhythmias, even under pharmacological treatment. We accessed the left atrium searching for pulmonary vein potentials, which indicate the presence of ectopic foci of activation, and radiofrequency was applied. In 2 cases we also documented atrial flutter that was successfully treated with ablation at the cavo-tricuspid isthmus. The patients tolerated the procedures well and they all are arrhythmia free 30 days after the intervention.

 fibrilación atrial flúter ablación radiofrecuencia potenciales de venas pulmonares atrial fibrillation flutter ablation radiofrequency pulmonary vein potentials Falk Rodney H Podrid P Atrial Fibrillation Cardiac Arrhythmia Mechanisms, diagnosis, and management Cardiac Arrhythmia Mechanisms, diagnosis, and management 1995 Baltimor^eMaryland William & Wilkins ed Cox JL The surgical treatment of atrial fibrillation J Thorac Cardiovasc Surg 1991 101 Mandapati R Skanes A Chen J Stable microreentrant sources as a mechanism of atrial fibrillation in the isolated sheep heart Circulation 2000 101 Pachon M JC Pachon M EI Pachon M JC Lobo TJ Pachon MZ Vargas RN A new treatment for atrial fibrillation based on spectral analysis to guide the catheter RF-ablation Europace 2004 6 Chen YJ Chen SA Electrophysiology of pulmonary veins J Cardiovasc Electrophysiol 2006 17 Hobbs WJ Fynn S Todd DM Wolfson P Galloway M Garratt CJ Reversal of atrial electrical remodeling after cardioversion of persistent atrial fibrillation in humans Circulation 2000 101 10 Fisher JD Spinelli MA Mookherjee D Krumerman AK Palma EC Atrial fibrillation: reaching the mainstream PACE 2006 29 Oral H Chugh A Good E Sankaran S Reich SS Igic P A tailored approach to catheter ablation of paroxysmal atrial fibrillation Circulation 2006 113 Pappone C Santinelli V Manguso F Vicedomini G Gugliotta F Augello G Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial Fibrillation Circulation Jan 20 04 109 Oral H Pappone C Chugh A Good E Bogun F Pelosi F Circunferential pulmonary vein ablation for chronic atrial fibrillation N Engl J Med 2006 3354 Wood M Mahoney C Kay N Ellenbogen K Clinical outcomes after ablation and pacing therapy for atrial fibrillation Circulation 2000 101 Borro GL Luzi M Sagone A Atrial fibrillation: the remodelling phenomenon Eur Heart J 2003 5 ^sSuppl. H
S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100008 Electrocardiograma del mes Araya Gómez Dra. Vivien ,Centro Cardiológico Integral 01 2007 2007 9 45 46
S1409-414220070001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000100009 Carta al editor Araya Gómez Dra. Vivien ,Cardióloga lectrofisióloga 01 2007 2007 9 46 46