S1409-414220070002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000200001 Revascularización miocárdica: cirugía o angioplastía? Gutiérrez S Oswaldo ,Revista Costarricense de Cardiología 05 2007 2007 9 3 4
S1409-414220070002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000200002 Proteína C Reactiva en el pronóstico de la insuficiencia cardiaca Reales Figueroa Dr. Pedro Hamad Dr. Ibrahim Pascual García Dr. Francisco J Carazo Marín Dr. Angel F Casado Almeida Dr. Miguel A García Forcada Dr. Angel ,Hospital Gutiérrez Ortega de Valdepeñas 05 2007 2007 9 5 10

Introducción. La insuficiencia cardiaca (IC) es un complejo síndrome clínico en el que están implicados múltiples factores; entre ellos los neurohormonales los cuales generan radicales libres de oxígeno (RO-) y producen activación de mediadores inflamatorios, como la proteína C Reactiva (PCR). A pesar de los importantes avances en las estrategias de tratamiento, el pronóstico de la IC es sombrío y difícil de predecir. Distintos biomarcadores (hormonas, marcadores de injuria tisular, marcadores inflamatorios, citocinas y antígenos) han demostrado su función como indicadores independientes del pronóstico, tanto a corto como a largo plazo en pacientes con IC; pero existen pocos estudios sobre la utilidad de la PCR en la estratificación del pronóstico de IC. Objetivo. Determinar el estado pro-inflamatorio de nuestros pacientes con IC, midiendo el perfil sérico de PCR y evaluando el posible valor pronóstico de este marcador para mortalidad y días de hospitalización; además estudiar la correlación entre valores de PCR y la clase funcional New York Heart Association (NYHA). Método. Se estudiaron prospectivamente 180 pacientes admitidos consecutivamente a nuestro Servicio con el diagnóstico de IC, durante el periodo de 1 año. Se realizó el dosaje de PCR al ingreso y se compararon los valores encontrados entre los pacientes que fallecieron y los que sobrevivieron, con los días de hospitalización y entre diferentes clases funcionales de NHYA. Resultados. Encontramos diferencias con significación estadística en PCR vs. mortalidad, en PCR vs. estancia hospitalaria y solo entre clase funcional I-II vs. clase funcional III-IV. Conclusión. Aunque los resultados obtenidos nos pueden ayudar a tomar algunas decisiones, el nivel de evidencia sobre este punto resulta insuficiente para incorporarlos a la práctica asistencial en forma sistemática, por lo que la información actual debe ser validada en futuros estudios prospectivos.

Introduction. Heart failure is a complex syndrome in which many factors are implicated, such as neurohormones with oxygen free radicals and markers of inflammation activation such as C -reactive protein (CRP). Despite significant advances in treatment strategies the prognosis is poor and difficult to predict, different biomarkers (hormones, markers of cellular injury and inflammation, cytokines and antigens) have been shown to serve as independent prognostic indicators, in both the short and long term heart failure patient. Objectives. To find out the proinflammatory state of patients with this syndrome, determining if CRP levels have prognostic value for mortality and during hospitalisation and to find out the relationship between CRP levels and NYHA functional classes I-IV. Methods. All 180 consecutive patients that were admitted to our service during a one year period with the diagnosis of heart failure, were prospectively enrolled. We look for differences in CPR levels between survivors and no survivors, regarding days of hospitalization and between different NYHA functional class groups. Results. We observed statistically significant differences between CRP levels regarding mortality and during hospitalisation, but only between NYHA classes I -II vs III - IV. Conclusion. At the present time, there is insufficient evidence available to enable the markers to be incorporated into routine clinical practice, current data must be validated in future prospective studies.

 Insuficiencia cardiaca (IC) Proteína C reactiva (PCR) Pronóstico Heart failure C-reactive protein Prognosis Sosa Liprandi A Función de los marcadores humorales en la evaluación pronóstica de la insuficiencia cardiaca Rev Esp Cardiol 2005 58 Khand A Gemmel I Clark AL Cleland JG Is the prognosis of heart failure improving? J Am Coll Cardiol 2000 36 Vidal Barbara Valor pronostico de citocinas y neurohormonas en la insuficiencia cardiaca severa Rev Esp Cardiol 2002 55 5 Horwich TB Patel J MacLellan WR Fonarow GC Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure Circulation 2003 108 Ishii J Nomura M Nakamura Y Naruse H Mori Y Ishikawa T Risk stratification using a combination of cardiac troponin T and brain natriuretic peptide in patients hospitalized for worsening chronic heart failure Am J Cardiol 2002 89 Swedberg K Eneroth P Kjekshus J Wilhelmsen L Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality Circulation 1990 82 Francis GS Cohn JN Johnson G Rector TS Goldman S Simon A Plasma norepinephrine, plasma renin activity, and congestive heart failure. Relations to survival and the effects of therapy in V-HeFT II. The V-HeFT VA Cooperative Studies Group Circulation 1993 87 ^s6 Benedict CR Francis GS Shelton B Johnstone DE Kubo SH Kirlin P Effect of long-term enalapril therapy on neurohormones in patients with left ventricular dysfunction. SOLVD Investigators Am J Cardiol 1995 75 Richards AM Doughty R Nicholls MG Macmahon S Ikr. am H Sharpe N Neurohumoral prediction of benefit from carvedilol in ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group Circulation 1999 99 Cohn J Heart failure: MOXCON (Moxonidine for Congestive Heart Failure) Circulation 1999 100 Tsutamoto T Wada A Maeda K Hisanaga T Maeda Y Fukai D Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction Circulation 1997 96 Maisel A Hollander JE Guss D McCullough P Nowak R Green G Rapid Emergency Department Heart Failure Outpatient Trial investigators. Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT). A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath J Am Coll Cardiol 2004 44 Wang TJ Larson MG Levy D Benjamin EJ Leip EP Omland T Plasma natriuretic peptide levels and the risk of cardiovascular events and death N Engl J Med 2004 350 Bettencourt P Frioes F Azevedo A Dias P Pimenta J Rocha-Goncalves F Prognostic information provided by serial measurements of brain natriuretic peptide in heart failure Int J Cardiol 2004 93 Perna ER Macin SM Parras JI Pantich R Farias EF Badaracco JR Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema Am Heart J 2002 143 Sosa Liprandi MI Sosa Liprandi A Barbagelatta A Garcia Ben M Latorraga C Orlandini C Troponin T but not high sensitivity C-reactive protein, predict outcome in patient hospitalized with acute decompensate heart failure J Card Fail 2003 9 Sato Y Yamada T Taniguchi R Nagai K Makiyama T Okada H Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes Circulation 2001 103 Levine B Kalman J Mayer L Elevated circulating levels of tumor necrosis factor in severe chronic heart failure N Engl J Med 1990 223 Arai K Lee F Miyajima A Citokines: coordinators of immune and inflammatory responses Ann Rev Biochem 1990 59 Matsumori A Yamada T Susuki H Increased circulating cytokines in patients with myocarditid and cardiomyopathy Br Heart J 72 Mann DL Young JB Basic Mechanisms in congestive heart failure: Recognizing the role of pro inflammatory cytokines Chest 1994 105 Hosenpud JD Campbell SM Mendelson DJ Interleukin-1-induced myocardial depression in an isolated heart preparation J Heart Transplant 1989 8 MacGowan GA Mann DL Kormos RL Circulating interleukin-6 in severe heart failure Am J Cardiol 1997 79 Tsutamoto T Hisanaga T Wada A Interleukin-6 spillver in the peripheral circulation increases with the severity of heart failure, and high plasma level of interleukin-6 is an important prognostic predictor in patients with congestive heart failure J Am Coll Cardiol 1998 31 Mann DL Knueferman P Baumgarten G Cytokines in ischemic heart disease Dialogues in Cardiovascular Medicine 2000 5 D’Aloia A Faggiano P Aurigemma G Bontempi L Ruggeri G Metra M Serum levels of carbohydrate antigen 125 in patients with chronic heart failure: relation to clinical severity, hemodynamic and Doppler echocardiographic abnormalities, and short-term prognosis J Am Coll Cardiol 2003 41 Anand I Latini R Masson S Judo D Chiang Y Glazer R Prognostic value of plasma C-reactive protein in heart failure. Results from Val-HeFT J Am Coll Cardiol 2004 43 ^sA Berry C Hogg K Stevenson K Norrie J McMurray JJ Relationship between plasma C-reactive protein concentration on admission and long term outcome in unselected hospitalized heart failure patients J Am Coll Cardiol 2004 43 ^sA Augier N Macín SM Címbaro Canella JP Perna ER Pitzus AE Prevalencia e implicancia pronóstica de la proteína C reactiva en la insuficiencia cardíaca crónica. 3er Congreso Internacional de Cardiología por Internet Prevalencia e implicancia pronóstica de la proteína C reactiva en la insuficiencia cardíaca crónica. 3er Congreso Internacional de Cardiología por Internet Anand I Latini R Viorel G Kuskowski M Rector T Masson S Signorini S Mocarelli P Hester A Glazer R C-reactive protein in heart failure Circulation 2005 112 Pye M Rae AP Cobbe SM Study of C-reactive protein concentration in heart failure Br Heart J 1990 63 Martínez Virto A Marcadores inflamatorios y de estrés oxidativo en la insuficiencia cardiaca Rev Clin Esp 2005 205
S1409-414220070002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000200003 Tratamiento agresivo hipolipemiante en las enfermedades cardiovasculares Whayne, Jr Thomas F ,Universidad de Kentucky 05 2007 2007 9 11 20

A 3 los factores de riesgo cardiovascular (CV) tradicionales hipercolesterolemia, hipertensión y tabaquismo, se agregó la diabetes mellitus. Hay muchos otros como la homocisteína y la lipoproteína(a), aunque de los beneficios de su tratamiento están por aclararse. También hay interés en los factores inflamatorios de riesgo CV, como la proteína C-reactiva ultra sensible (PCR-us) y la lipasa A2 asociada a las lipoproteínas (Lp-PLA2) cuyo dosaje está disponible comercialmente pero no es claro su rol en la práctica clínica de rutina. Sin embargo, todavía las lipoproteínas de baja densidad (LDL) representan el estándar de oro para predecir el riesgo CV. Con las dislipidemias de lipoproteínas específicas y los pacientes de difícil manejo, es importante individualizar su tratamiento con dietas y fármacos alternativos. Existieron percepciones erróneas como la creencia que solamente los caucásicos del mundo occidental y los varones tenían riesgo CV significativo. Ahora se sabe que muchos otros grupos étnicos también sufren enfermedades CV, especialmente los que viven en población urbana y que las mujeres incluso tienen peor pronóstico si se presentan antes de los 50 años de edad. Quizás el problema médico más importante en este momento es el síndrome metabólico, que en combinación junto a los demás factores de riesgo CV multiplica el riesgo total. Los tratamientos futuros involucrarán a la genética pero, por ahora, el uso agresivo de medicamentos puede modificar favorablemente el riesgo CV, más no eliminarlo.

To the 3 major traditional risk factors for cardiovascular (CV) disease consisting of hypercholesterolemia, hypertension and cigarette smoking, an essentially equal fourth can be added, namely diabetes mellitus. There are many other risk factors such as elevated levels of homocysteine and lipoprotein (a) but the benefit of their treatment remains to be clarified. Also, there is an interest in inflammatory risk factors for CV disease such as high sensitivity C-reactive protein and lipoprotein-associated phospholipase A2, the measurement of both is commercially available, however their role in routine clinical practice is not clearly established. Therefore, low density lipoproteins (LDL) remain the gold standard to predict CV risk. For dyslipidemias involving specific lipoproteins and for patients that are difficult to manage, it is important to individualize the treatment with specific diets and targeted medications. There exist erroneous perceptions in CV medicine such as the thought that only caucasians of the Western World and males have a significant CV risk. However, it is now known that many other ethnic groups also suffer from various CV diseases, especially in urban populations. Also, women as a group have a worse prognosis than men if they present with a myocardial infarction before the age of 50. Perhaps the most important medical problem of the current era is the metabolic syndrome in which the combination of multiple CV risk factors multiplies the total CV risk. Future management of CV disease will involve genetics but for now, the aggressive use of medications may not eliminate CV risk but can very favorably modify the severity and clinical significance of that risk and lead to better clinical outcomes. Key-words: Atherosclerosis, vascular disease, cardiovascular risk factors, inflammation, high density lipoproteins, low density lipoproteins, very low density lipoproteins, metabolic syndrome.

 Aterosclerosis enfermedad vascular factores de riesgo cardiovascular inflamación lipoproteínas de alta densidad lipoproteínas de baja densidad lipoproteínas de muy baja densidad síndrome metabólico Sytkowski P Kannel WB D’Agostino RB Changes in risk factors and the decline in mortality from cardiovascular disease. 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The safety and efficacy of achieving very low low-density lipoprotein with intensive statin therapy J Am Coll Cardiol 2005 46 Pullinger C Hillas E Hardman DA Two apolipoprotein B gene defects in a kindred with hypobetalipoproteinemia, one of which results in a truncated variant, apoB-61, in VLDL and LDL J Lipid Res 1992 33 Rabkin S Ledwich R Mymin D Myocardial infarction in familial hyper-alpha and hypo-beta-lipoproteinaemia Postgrad Med J 1981 57 Arbustini E DelBello B Morbini P Plaque erosion is a major substrate for coronary thrombosis in acute myocardial linfarction Heart 1999 82 Hernandez F Illnait J Mas R Effect of Policosanol on Serum Lipids and Lipoproteins in Healthy Volunteers Curr Ther Res 1992 51 Berthold H Unverdorben S Degenhardt R Bulitta M Gouni-Berthold I Effect of Policosanol on Lipid Levels Among Patients with Hypercholesterolemia or Combined Hyperlipidemia JAMA 2006 295 Wright C Zielke J Whayne TF Policosanol, an aliphatic alcohol sugarcane derivative: use in patients intolerant of or inadequately responsive to statin therapy Internat J Angiol 2005 13 Fernandez J Eficacia y Tolerabilidad del Policosanol en Pacientes Argentinos con Hipercolesterolemia Tipo II Revista CNIC Cienc Biol 1999 30 Castano G Mas R Nodarse M One Year Study of Efficacy and Safety of Policosanol (5 mg twice daily) in the Treatment of Type II Hypercholesterolemia Curr Ther Res 1995 56 Randomised trial of cholesterol lowering in 4,444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) Lancet 1994 344 Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels N Engl J Med 1998 339 Downs J Clearfield M Weis S Whitney E Shapiro DR Beere PA Langendorfer A Stein EA Kruyer W Gotto AM Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS JAMA 1998 279 Shepherd J Cobbe SM Ford I Isles CG Lorimer AR MacFarlane PW McKillop JG Packard CJ Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group N Engl J Med 1995 333 Sacks F Pfeffer MA Moye LA Rouleau JL Rutherford JD Cole TG Brown L Warnica JW Arnold JM Wun CC Davis BR Braunwald E The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators N Engl J Med 1996 335
S1409-414220070002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000200004 Nacimiento anómalo de la arteria coronaria izquierda en un tronco común en el seno de Valsalva derecho López Dra. Giorjanela Quesada Dr. Luis Diego Con Dr. Pedro Díaz Dr. Geiner ,Hospital México 05 2007 2007 9 21 24

Se presenta el caso de una paciente de 36 años con antecedente de valvulotomía a los 14 años por estenosis pulmonar congénita, consultó por dolor torácico punzante y disnea de pequeños esfuerzos de 6 meses de evolución. La coronariografía mostró la arteria coronaria izquierda originándose de un tronco común con la arteria coronaria derecha y una lesión obstructiva severa en el origen de la arteria descendente anterior. La paciente fue referida para revascularización quirúrgica

A 36 year old female, who at age 14 underwent a pulmonary valvulotomy for congenital pulmonary stenosis, presented with chest pain and dyspnea with mild activity for the last 6 months. Coronary angiography revealed the left coronary artery originating from a common vessel with the right coronary artery, and severe stenosis at the origin of the left anterior descending artery. The patient was referred for surgical coronary revascularization.

 Estenosis pulmonar anomalía coronaria coronariografía Pulmonary stenosis coronary anomaly coronary angiography Angelini P Velasco JA Flamm S Coronary anomalies: incidence, pathophysiology and clinical relevance Circulation 2002 105 Silvia G Priori Aliot Etienne Blomstrom-Lundqvist Carina Bossaert Leo Breithardt Gunter Brugada Pedro Task Force on Sudden Cardiac Death of the European Society of Cardiology European Heart J 2001 22 Iskandar EG Thompson PD Exercise-related sudden death due to an unusual coronary artery anomaly Med Sci Sports Exerc 2004 36 Balaguer J Estornel J Vilar J Pomar F Federico P Payá F Arteria coronaria izquierda anómala en el seno de Valsalva derecho asociada a ateromatosis coronaria Rev Esp Cardiol 2005 58 Halawa B Cardiovascular diseases as a cause of sudden death in athletes Pol Merkuriusz Lek 2004 16 Iñiguez Romo A Macaya Miguel C Alfonso Moterola JA Sanromán Calvar JA Goikolea Ruiz-Gómez J Zarco Gutiérrez P Anomalías congénitas del origen anómalo de las arterias coronarias: un reto diagnóstico Rev Esp Cardiología 1991 44 García JM González-Juanatey JR Amaro A Anomalías congénitas del origen de las arterias coronarias aspectos diagnósticos y terapéuticos Rev Esp Cardiol 1994 47 Barriales R Morís C Anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral: ¿qué actitud se debe seguir? Rev Esp Cardiol 2006 59 4 Barriales-Villa R Morís C Sanmartín JC Fernández E patín F Ruiz Nodar JM Registro de anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral en 13 hospitales españoles (RACES) Rev Esp Cardiol 2006 59 Gómez R Muñoz J Sanchís J Insa L Casans I Valls A Chorro J López V Arteria coronaria única desde seno de Valsalva derecho. Una causa poco frecuente de isquemia miocárdica Rev Esp Cardiol 1998 51 Neil DA Bonser RS Townend JN Coronary arteries from a single coronary ostium in the right coronary sinus: a previusly reported anatomy Heart 2000 M ay 83 Braunwald E Braunwald E Valvular heart disease Tratado de cardiología Tratado de cardiología 1993 5 ^eNew York Mc Graw-Hill, Inc Otero Coto Eduardo Riesgos y Complicaciones de la Cirugía Cardíaca Riesgos y Complicaciones de la Cirugía Cardíaca Riesgos y Complicaciones de la Cirugía Cardíaca 2004 1
S1409-414220070002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000200005 Embolismo cerebral recurrente, foramen oval permeable e hipercoagulabilidad Gutiérrez Jaikel Dr. Luis Romero Triana Dr. Luis ,Hospital México San José Costa Rica 05 2007 2007 9 25 29

Se presenta el caso de una paciente con embolismo cerebral recurrente, formen oval permeable, hipercoagulabilidad y masa atrial derecha de aspecto semejante a mixoma atrial que durante el cierre quirúrgico, se documentó que correspondía a músculo atrial redundante.

We present the case of a patient with recurrent brain embolism, patent foramen ovale and hypercoagulable state, with a myxoma like mass in the right atrium that during the surgical time, was demonstrated to be redundant atrial muscle.

 embolismo cerebral hipercoagulabilidad foramen oval mixoma septum interatrial brain embolism hypercoagulable state patent foramen ovale myxoma interatrial septum Peters P Reinhardt S The echocardiographic evaluation of intracardiac masses: a review J Am Soc Echocardiogr 2006 19 Kizer J Devereux R Patent Foramen Ovale in Young Adults with Unexplained Stroke N Engl J Med 2005 353 Homma S Sacco R Patent foramen ovale and stroke Circulation 2005 112 Hassell K Hematologic ramifications of patent foramen ovale-role of hypercoagulable state Cardiol clin 2005 23 Seligsohn U Lunetsky A Genetic susceptibility to venous thrombosis N Engl J Med 2001 344 Plasma fibrinogen level and the risk of mayor cardiovascular diseases and nonvascular mortality JAMA 2005 294 Reynen K Cardiac Myxomas N Engl J Med 1995 333 Butany J Nair V Nassemuddin A Nair G Catton C You T Cardiac tumours: diagnosis and management Lancet Oncol 2005 6 Newman M Mathew J Grocott H Mackensen G Monk T Welsh-Bohmer A Central Nervous system injury associated with cardiac surgery Lancet 2006 368
S1409-414220070002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000200006 Quilopericardio Garita Jiménez Dr. Elliott Robelo Pentzke Dr. Bayardo Chamorro Castro Dr. Rodrigo Salazar Vargas Dr. Carlos ,Hospital Rafael A. Calderón Guardia 05 2007 2007 9 31 33

El quilopericardio es una entidad relativamente rara, inclusive para quienes nos dedicamos a tratar enfermos con patología del tórax. Generalmente existe una anomalía del conducto linfático o de sus tributarios, ya sea por neoplasias, o por lesiones. Estas últimas pueden ser civiles o iatrogénicas. En algunos pocos enfermos no se encuentra una causa clara y se les clasifica como de origen idiopático. El manejo inicial es mediante el drenaje y administración de dietas especiales, sin embargo un grupo de enfermos requiere cirugia que generalmente consiste en ligadura del conducto torácico. Presentamos 2 casos de pacientes con quilotórax, uno por linfangiomas y otro idiopático, ambos fueron finalmente intervenidos, evolucionando satisfactoriamente.

Chylopericardium is an uncommon condition even for medical personnel dedicated to the treatment of chest diseases. Usually there is an anomaly of the thoracic duct or of its tributaries, causing leakage of chyle inside the pericardial sac. Benign or malignant neoplasms and a variety of injuries can either obstruct or damage this structure, although in few cases no apparent cause is found. Initially the patients are handled by drainage and special diets; however some must be subjected to thoracic duct ligature. We present herein the cases of 2 patients with chylopericardium, 1 caused by lymphangiomas and the other idiopathic in nature, both underwent surgery with good results.

 Maisch B Ristic DR Practical aspects of the management of pericardial disease Heart 2003 89 Malthaner R.A Inculet RI Pearson FG Cooper JD Deslauriers J Ginsberg RJ Hiebert CA Patteron GA Urschel HC The thoracic duct and chylothorax Thoracic Surgery Thoracic Surgery 2002 2 ^ePhiladelphia Churchill Livingstone Groves LK Effler DB Primary chylopericardium N Engl J Med 1954 250 Alvarado M Salazar C Induni E Pucci JJ Méndez E Soto L Quilotórax derecho y quilopericardio como manifestación de enfermedad neoplásica maligna Acta Med Costarr 2000 42 ^sSupl Rodgers BM Kayser LR Kron IL Spray TL The thoracic duct and the management of chylothorax Mastery of Cardiothoracic Surgery Mastery of Cardiothoracic Surgery 1998 ^ePhiladelphia Lippincott-Raven Kan CD Wang JN Wu JM Yang YJ Isolated chylopericardium after intrapericardial procedures Tex Heart Inst J 2007 34 Riquet M Le Pimpec BF Souilamas R Hidden G Thoracic duct tributaries from intrathoracic organs Ann Thorac Surg 2002 73 De Menezes IC Araujo SG Damiao A Telo M Martins FM Macedo MM Lymphangioma of the mediastinum as a causeof chylopericardium Acta Med Port 1990 3 Mehrotra S Peeran NA Bandyopadhyay A Idiopathic chylopericardium Tex Heart Inst J 2006 33 Rose DM Colvin SB Danilowicz D Isom OW Cardiac tamponade secondary to chylopericardium following cardiac surgery: case report and review of the literature Ann Thorac Surg 1982 34
S1409-414220070002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000200007 Mutación de la proteína de Desmosoma Plakofilina-2 en una familia guanacasteca Gutiérrez S Dr. Oswaldo Busse Dr. Andreas Priori Dra. Silvia G Napolitano Dr. Carlo Bloise Dra. Raffaella ,Hospital México ,Universidad de Costa Rica ,Molecular Cardiology Laboratories Italy 05 2007 2007 9 35 36

Se reporta una mutación en la plakofilina-2, proteína del Desmosoma miocárdico, encontrada en dos pacientes de una misma familia procedente de Guanacaste, Costa Rica, portadores de Displasia/cardiomiopatía arritmogénica del ventrículo derecho sintomática (ARVC) y tratados con cariodesfibrilador implantable

We report a desmosomal plakophilin-2 mutation detected in two familiy members coming from Guanacaste, Costa Rica, carriers of symptomatic arrhythmogenic right ventricular cardiomyopathy (ARVC), both treated with implantable cardiodesfibrillator.

 Plakofilina-2 Desmosoma Displasia/cardiomiopatía arritmogénica del ventrículo derecho (ARVC) plakophilin-2 Desmosome Arrhythmogenic right ventricular dysplasia (ARVC) Gutiérrez O Reporte de una Familia Guanacasteca con Displasia Arritmogénica del ventrículo derecho Rev Costarr Cardiol 2003 5 Gerull B Heuser A Wichter T Paul M Basson C. T McDermott D. A Lerman B. B Markowitz S. M Ellinor P. T MacRae C. A Peters S Grossmann K. S Michely B Sasse-Klaassen S Birchmeier W Dietz R Breithardt G Schulze-Bahr E Thierfelder L Mutations in the desmosomal protein plakophilin-2 are common in arrhythmogenic right ventricular cardiomyopathy Nature Genet 2004 36 Ulate G Ulate A El calcio en los miocitos cardiacos y su papel en la miocardiopatías Rev Costarr Cardiol 2006 8 Koeser J Troyanovsky SM Grund C Franke WW De novo formation of desmosomes in cultured cells upon transfection of genes encoding specific desmosomal components Exp Cell Res 2003 A pr 285 1 Kowalczyk AP Borgwardt JE Green KJ Analysis of desmosomal cadherinadhesive function and stoichiometry of desmosomal cadherin-plakoglobin complexes J Invest Dermatol 1996 S ep 107 3 Priori SG Napolitano C Memmi M Colombi B Drago F Gasparini M DeSimone L Coltorti L Bloise R Keegan R Cruz Filho F Vignati G Benatar A DeLogu A Clinical and Molecular Characterization of Patients With Catecholaminergic Polymorphic Ventricular Tachycardia Circulation 2002 106 Beffagna G Occhi G Nava A Vitiello L Ditadi A Basso C Bauce B Carraro G Thiene G Towbin JA Danieli GA Rampazzo A Regulatory mutations in transforming growth factor-beta3 gene cause arrhythmogenic right ventricular cardiomyopathy type 1 Cardiovasc Res 2005 F eb 65 2 Goldberg SR McKinstry RP Sykes V Lanning DA Rapid closure of midgestational excisional wounds in a fetal mouse model is associated with altered transforming growth factor-beta isoform and receptor expression J Pediatr Surg 2007 J un 42 6 Moioli EK Mao JJ Chondrogenesis of Mesenchymal Stem Cells by Controlled Delivery of Transforming Growth Factor-beta3 Conf Proc IEEE Eng Med Biol Soc 2006 1 Tomé MT García-Pinilla JM McKenna W Update in arrhythmogenic right ventricular cardiomyopathy: genetic, clinical presentation and risk stratificaction Rev Esp Cardiol 2004 57 Moric-Janiszewska E Markiewicz-Loskot G Review on the genetics of arrhythmogenic right ventricular dysplasia Europace 2007 9
S1409-414220070002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000200008 Electrocardiograma del mes Araya Gómez Dra. Vivien ,Centro Cardiológico Integral 05 2007 2007 9 37 38