S1409-414220070003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000300001 La obesidad y el riesgo cardiovascular Arguedas Ch Carlos Rojas V Raquel García G Luis ,Universidad de Costa Rica San José Costa Rica 09 2007 2007 9 3 5
S1409-414220070003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000300002 Angioplastia con "STENTS ": Estado actual Whayne,Jr Thomas F ,Universidad de Kentucky Lexington Kentucky EE.UU 09 2007 2007 9 7 10
S1409-414220070003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000300003 Valoración psicológica perioperatoria en pacientes sometidos a cirugía cardiovascular León Castro Adriana Salazar Vargas Carlos ,Hospital Rafael A.Calderón Guardia 09 2007 2007 9 11 15

Introducción:Actualmente las enfermedades cardiovasculares son la causa más frecuente de mortalidad. Los pacientes que ingresan a los hospitales y son sometidos a exámenes invasivos y a procedimientos cardiológicos o cardioquirúrgicos perciben al corazón como el centro de la vida, lo cual causa ansiedad y depresión. El objetivo de este estudio fue determinar el impacto psicológico que la recomendación de una intervención cardiovascular causa sobre los enfermos. Método: 100 pacientes consecutivos fueron operados de septiembre 2005 a enero 2007 de diferentes cardiopatías, todos fueron entrevistados por una psicóloga antes de la cirugía. Aparte de las preguntas demográficas, fueron interrogados en 2 áreas; una en que se exploró su conocimiento de la enfermedad y el grado de comprensión obtenido después de la explicación de un profesional y la otra, en que se recogieron los sentimientos, pensamientos y expectativas originados por la recomendación quirúrgica. Resultados: Fueron 67 hombres y 33 mujeres, con edades promedio de 55 y 50 años respectivamente. Poco más de la mitad apenas cursaron la educación primaria, 9 no tuvieron acceso a educación formal y el resto terminó estudios superiores. Aunque la gran mayoría dijo haber entendido su enfermedad, solo la mitad pudo explicarla adecuadamente, menos de la mitad pudo describir la intervención propuesta y ¾ partes desconocían cómo era la evolución postoperatoria. En relación con los temores percibidos, casi la mitad indicó tener miedo a morir en la sala de operaciones, un 1/5 a morir por la anestesia el resto expresó diversas aprensiones. La gran mayoría indicó temer quedar con un problema físico postoperatorio y 40 pacientes expresaron preocupación por no poder eventualmente, cuidar o afrontar sus obligaciones familiares. Otros aspectos que causaron gran preocupación eran el rendimiento sexual a situación económica y laboral. Como manera de enfrentar los temores anotados, 25 dijeron que "lo harían con fe en Dios ", 26 con ayuda del equipo tratante, y 49 cambiando su conducta hacia un estilo de vida saludable; quince con ayuda familiar y el resto los afrontarían conforme se presentaran. Todos los enfermos esperaban que la intervención fuese un éxito. Casi la mitad expresaron querer mejorar su vida, un 1/3 poder volver a llevar una vida normal, un ¼ volver a trabajar y no tener problemas físicos y el resto "lo dejaban en manos de Dios ". Conclusión: La indicación de cirugía cardiovascular despierta en el paciente una serie de temores que causan angustia, depresión y miedo a la pérdida de control. El profesional debe de explicar al paciente de manera sencilla y veraz su situación y debe de brindarle la oportunidad de aclarar sus dudas. La intervención de un(a) psicólogo(a) en este período perioperatorio es de mucha ayuda para que el paciente tolere mejor la situación tenga un postoperatorio más exitoso.

Psychological perioperative evaluation in patients undergoing cardiovascular surgery Introduction:Nowadays cardiovascular diseases are the commonest cause of mortality and cardiac surgery is commonly prescribed for some. The main objective of this study was to determine the impact caused by this recommendation upon the patients. Methods: From September 2005 to January 2007, 100 consecutive patients were operated upon All were interviewed before surgery by a psychologist,besides demographic questions,2 areas were explored,1 to asses the knowledge of their disease and understanding of the proposed intervention after having had an explanation by a health care provider and the other to determine the impact of the coming surgery upon their fears, feelings, thoughts and expectations. Results: There were 67 males and 33 females, (mmean age 55 and 50 respectivlely). Slightly over half, had only finished primary school, 9 did not have any schooling and the rest had either high school or college degrees. Even though a great majority claimed to have understood their disease, only half were able to give an adequate account of it.Less than half,could describe the recommended procedure and ¾knew nothing of the postoperative course. Regarding their fears, about half of the group was fearful of dying in the operating room, a fifth of dying from anesthesia and the rest were anxious from different reasons. A large percentage was fearful of postoperative side effects, and 40 were worried of their capacity to carry on their family obligations. Sexual performance and their economical and employment status were also cause of preoccupation. When asked how would they handle the fears listed above,25 said "with faith in God ",26 said with the help of the treating team, and 49 by changing towards a healthier lifestyle, 15 with family support and the rest "would confront them as they came " All the patients expected the surgery to be a complete success. Almost half wanted to improve their lives, 1/3 to be able to carry on a normal life,a ¼whished to return to work,and the rest placed their future in "God ’s hands ". In summary the recommendation of a cardiac operation induces fears that cause anxiety, depression and a sense of loss of control.The patient should be approached in a clear and easy manner,giving him chance to ask questions and to get rid of all his doubts. sychological ntervention uring this eriod is f paramount importance, o he an olerate this tressful situation and to help collaborate with his postoperative recovery.

 Valoración psicológica intervención cardiovascular depresión Psicological evaluation cardiovascular intervention depression Memorias del Ministerio de Salud, Costa Rica Memorias del Ministerio de Salud, Costa Rica Karl A Slaikeu.Intervención en Crisis.Manual para Práctica e Investigación Slaikeu.Intervención en Crisis.Manual para Práctica e Investigación 1996 6 Editorial El Manual Moderno Fitzsimons D Parahoo K Richardson SG Stringer M Patient anxiety while on a waiting list for coronary by pass surgery: a qualitative and quantitative analysis Heart-Lung 2003 32 Underwood MJ Firmin RK Jehu D Aspects of psychological and social morbidity in patients awaiting coronary artery bypass grafting British Heart J 1993 69 Lesperance F Frasure-Smith N Depression in patients with cardiac disease: a practical review J Psychosom Res 2000 48 Boersma S A self regulation perspective on emotional distress and health related quality of life after myocardial infarction A self regulation perspective on emotional distress and health related quality of life after myocardial infarction 2004 Rotterdam Óptima Rodriguez T Gonzalez C Falcon A Necesidad estratégica de la comprensión de las emociones en la terapéutica cardiovascular Emmons RA King LA Conflict among personal strivings: inmediate and long term implications for psychological and physical well being J Pers Soc Psychol 1988 54 Giacomonte E Mejía A Estrés Preoperatorio y Riesgo Quirúrgico (El impacto emocional de la cirugía) Estrés Preoperatorio y Riesgo Quirúrgico (El impacto emocional de la cirugía) 1997 Buenos Aires Paidós Castillero Amador Y Pérez Lazo de la Vega M Preparación Psicológica para la Cirugía Mayor Revista Electrónica de motivación y Emoción (REME) 2003 6 Case RB Heller SS Case NB Moss AJ Type A Behavior and Survival after Acute Myocardial Infarction N Engl J Med 1985 312 Heller S S Frank KA Malm JR Bowman FO Harris PD Charlton MH Psychiatric complications of open-heart surgery. A re-examination N Engl J Med 1970 283 Manual ACSM para la Valoración y Prescripción del Ejercicio Manual ACSM para la Valoración y Prescripción del Ejercicio 1999 Barcelona Editorial Paidotribo Guidelines for Cardiac Rehabilitation Programs Guidelines for Cardiac Rehabilitation Programs 1995 ^eIllinois Human Kinetics Books Astrand P Exercise Physiology and its Role in Disease Prevention and Rehabilitation Arch Med Rehab 1986 68 Astrand P Fisiología del Trabajo Físico Fisiología del Trabajo Físico 1986 Buenos Aires Editorial Panamericana Paffenbarger R Hyde R Wing A Lee M Jung D Kampert J The association of changes in physical activity level and other lifestyle characteristics with mortaly among men New Eng J Med 1985 28
S1409-414220070003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000300004 Efecto de la actividad física en la reducción del riesgo de enfermedad cardiovascular mediante el control del peso corporal Martínez-Ortiz José A ,Universidad de Costa Rica 09 2007 2007 9 17 22

La obesidad es un padecimiento complejo que ha alcanzado niveles de epidemia mundial y constituye un importante riesgo de enfermedad cardiovascular. En el 2005, el 40.5% de la población adulta estadounidense era físicamente inactiva (sedentaria), un año antes la prevalencia de obesidad, en la misma población, era de 32.1% (un aumento de 37.8% en una década).. Existen pocos trabajos publicados que valoran el efecto de la actividad física (AF) en la pérdida inicial peso y en el mantenimiento del nuevo peso después de un período de seguimiento igual o mayor a 1 año. La evidencia indica que el efecto del gasto de energía por AF incrementa la pérdida de peso, mejora la conservación del nuevo peso durante el período de seguimiento (2 años), disminuye la pérdida de masa magra que produce la pérdida de peso, mejora el control de la ingesta de energía y no produce un incremento compensatorio en el corto plazo en la ingesta de energía. Los programas exitosos de pérdida de peso y mantenimiento del peso perdido incluyen un aumento en la AF. Es necesario hacer estudios aleatorizados y controlados de pérdida de peso y mantenimiento del nuevo peso que incluyan aumentos en la AF antes, durante y después de la restricción de la ingesta de calorías y sus diferentes combinaciones que permita estimar la magnitud de cada efecto.

The effect of physical activity over cardiovascular risk reduction by means of weight control Obesity is a complex ailment that has reached worldwide epidemic proportions and plays a key role in the development of cardiovascular disease. In 2005, 40.5%of US adults were physically inactive (sedentary),a year before the prevalence of obesity in the same population was 32.11% (a 37.8% increase in a decade). There are only few published papers on the effect of physical activity (PA) on the initial weight loss and its maintenance after at least 1 year. The evidence indicates that the effect of energy spent through PA, increases weight loss, improves the maintenance of the weight lost after a period of at least 2 years, decreases the lean mass lost as a consequence of weight loss intervention, improves the control of energy intake and does not affect the short term compensatory increase in energy intake. Successful weight loss and weight loss maintenance programs include an increase in PA. It is necessary to conduct weight loss and weight loss maintenance randomized controlled trials which include increases in PA before, during and after restriction of energy intake, and all combinations in order to determine the contribution of each individual effect.

 obesidad sobrepeso actividad física pérdida de peso peso corporal Obesity overweight physical activity weight loss body weight Japanese officials bare bellies online to fight obesity Japanese officials bare bellies online to fight obesity Diet blog for Japaneses ministers Diet blog for Japaneses ministers Estrategia Global contra la Obesidad (EGO Chile), Santiago, junio 2006 Estrategia Global contra la Obesidad (EGO Chile), Santiago, junio 2006 Sáenz Madrigal M Encuesta multinacional de diabetes mellitus, hipertensión arterial y factores de riesgo asociados. Área metropolitana San José Encuesta multinacional de diabetes mellitus, hipertensión arterial y factores de riesgo asociados. Área metropolitana San José Kabagambe EK Baylin A Campos H Nonfatal acute myocardial infarction in Costa Rica: modifiable risk factors, population-attributable risks, and adherence to dietary guidelines Circulation 2007 M ar 115 Lanas F Avezum A Bautista LE Diaz R Luna M Islam S Yusuf S INTERHEART Investigators in Latin America. Risk factors for acute myocardial infarction in Latin America: the INTERHEART Latin American study Circulation 2007 115 Smith SC Jr Risk factors for myocardial infarction in Latin America: sobrepeso y obesidad Circulation 2007 115 Hills AP Byrne NM State of the science: a focus on physical activity Asia Pac J Clin Nutr 2006 15 ^sSuppl Lang A Froelicher ES Management of overweight and obesity in adults: behavioral intervention for long-term weight loss and maintenance Eur J Cardiovasc Nurs 2006 5 Hill JO Understanding and addressing the epidemic of obesity: an energy balance perspective Endocr Rev 2006 27 Avenell A Sattar N Lean M ABC of obesity. Management: Part I--behaviour change, diet, and activity BMJ 2006 333 Goldberg J Bucciarelli A A Century of Low-Carbohydrate Diets Nutr Today 2006 41 Dansinger ML Gleason JA Griffith JL Selker HP Schaefer EJ Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial JAMA 2005 293 1 Encuesta Nacional de Salud 2003, Santiago, marzo 2004 Encuesta Nacional de Salud 2003, Santiago, marzo 2004 Di Pietro L Dziura J Blair SN Estimated change in physical activity level (PAL) and prediction of 5-year weight change in men: the Aerobics Center Longitudinal Study Int J Obes 2004 28 Weiss EC Galuska DA Khan LK Serdula MK Weight-control practices among U.S. adults, 2001-2002 Am J Prev Med 2006 31 Health, United States, 2007. With Chartbook on Trends in the Health of Americans Health, United States, 2007. With Chartbook on Trends in the Health of Americans 2007 ^eMaryland Hyattsville van der Merwe MT Pepper MS Obesity in South Africa Obes Rev 2006 7 Chen Y Mao Y Obesity and leisure time physical activity among Canadians Prev Med 2006 42 York DA Rössner S Caterson I Chen CM James WP Kumanyika S Martorell R Vorster HH Prevention Conference VII: Obesity, a worldwide epidemic related to heart disease and stroke: Group I: worldwide demographics of obesity Circulation 2004 N ov 110 18 Curioni CC Lourenço PM Long-term weight loss after diet and exercise: a systematic review Int J Obes (Lond) 2005 29 Haslam DW James WP Obesity Lancet 2005 366 Glass RM Molter J Hwang MY Educating patients: one-year anniversary of the JAMA Patient Page JAMA 1999 281 Warburton DE Nicol CW Bredin SS Health benefits of physical activity: the evidence Can Med Assoc J 2006 174 Lean M Lara J Hill JO ABC of obesity. Strategies for preventing obesity BMJ 2006 333 Stubbs RJ Tolkamp BJ Control of energy balance in relation to energy intake and energy expenditure in animals and man: an ecological perspective Brit J Nutr 2006 95 Anderson JW Konz E Frederich RC Wood CL Long-term weight-loss maintenance: a meta-analysis of US studies Am J Clin Nutr 2001 74 Holden JH Darga LL Olson SM Stettner DC Ardito EA Lucas CP Long-term follow-up of patients attending a combination very-low calorie diet and behavior therapy weight loss programme Int J Obes Relat Metab Disord 1992 16 Hartman WM Stroud M Sweet DM Saxton J Long-term maintenance of weight loss following supplemented fasting Int J Eat Disord 1993 14 Pavlou KN Krey S Steffee Exercise as an adjunct to weight loss and maintenance in moderately obese subjects Am J Clin Nutr 1989 49 ^s5Suppl Sikand G Kondo A Foreyt JP Jones PH Gotto AM Jr Two-year follow-up of patients treated with a very-low-calorie diet and exercise training J Am Diet Assoc 1988 88 Ewbank PP Darga LL Lucas CP Physical activity as a predictor of weight maintenance in previously obese subjects Obes Res 1995 3 Flynn TJ Walsh MF Thirty-month evaluation of a popular very-low-calorie diet program Arch Fam Med 1993 2 Skender ML Goodrick GK Del Junco DJ Reeves RS Darnell L Gotto AM Foreyt JP Comparison of 2-year weight loss trends in behavioral treatments of obesity: diet, exercise, and combination interventions J Am Diet Assoc 1996 96 Walsh MF Flynn TJ A 54-month evaluation of a popular very low calorie diet program J Fam Pract 1995 41 Mougios V Kazaki M Christoulas K Ziogas G Petridou A Does the intensity of an exercise programme modulate body composition changes? Int J Sports Med 2006 27 Stiegler P Cunliffe A The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss Sports Med 2006 36 Williams PT Nonlinear relationships between weekly walking distance and adiposity in 27,596 women Med Sci Sports Exerc 2005 37 Heilbronn LK de Jonge L Frisard MI DeLany JP Larson-Meyer DE Rood J Nguyen T Martin CK Volaufova J Most MM Greenway FL Smith SR Deutsch WA Williamson DA Ravussin E Effect of 6-month calorie restriction on biomarkers of longevity, metabolic adaptation, and oxidative stress in overweight individuals: a randomized controlled trial JAMA 2006 295 Fogelholm M Kukkonen-Harjula K Does physical activity prevent weight gain--a systematic review? Obes Rev 2000 1 Wing RR Phelan S Long-term weight loss maintenance Am J Clin Nutr 2005 82 ^s1 Suppl Bazzano LA Song Y Bubes V Good CK Manson JE Liu S Dietary intake of whole and refined grain breakfast cereals and weight gain in men Obes Res 2005 13 Jakicic JM Otto AD Physical activity recommendations in the treatment of obesity Psychiatr Clin North Am 2005 28 Jakicic JM Otto AD Treatment and prevention of obesity: what is the role of exercise? Nutr Rev 2006 64 2 Pt 2 Jakicic JM Clark K Coleman E Donnelly JE Foreyt J Melanson E Volek J Volpe SL American College of Sports Medicine position stand. Appropriate intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 2001 33 Vogels N Egger G Plasqui G Westerterp KR Estimating changes in daily physical activity levels over time: implication for health interventions from a novel approach Int J Sports Med 2004 25 Warburton DE Nicol CW Bredin SS Prescribing exercise as preventive therapy Can Med Assoc J 2006 174 Jakicic JM Winters C Lang W Wing RR Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial JAMA 1999 282 Hills AP Byrne NM Physical activity in the management of obesity Clin Dermatol 2004 22 Ekkekakis P Lind E Exercise does not feel the same when you are overweight: the impact of self-selected and imposed intensity on affect and exertion Int J Obes (Lond) 2006 30
S1409-414220070003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000300005 Hiperaldosteronismo hiporreninémico supresible con glucocorticoides. Reporte de un caso y revisión de la literatura Villarroel Abrego Hugo ,Universidad Salvadoreña Alberto Masferrer 09 2007 2007 9 23 28

Se presenta el caso de un paciente de 57 años de edad, hipertenso severo y refractario, tratado sin éxito con 4 drogas antihipertensivas. El cuadro se asociada a debilidad muscular, alcalosis metabólica, hipokalemia severa y kaliuresis aumentada. Después de un exhaustivo estudio y varios ensayos terapéuticos en secuencia, se concluyó que este caso de hiperaldosteronismo hiporreninémico correspondía a la rara patología genética conocida como hiperaldosteronismo supresible con glucocorticoides. Hasta donde el autor sabe este es el primer caso reportado en Centroamérica de esta entidad. Se hace una revisión sobre el tema.

Glucocorticoid-supressible hyporeninemic hyperaldosteronism. A case report and literature review This case report is about a male 57-years patient, with severe and refractary arterial hypertension, treated unsuccesfully with four antihypertensive drugs. Besides there was muscular weakness, metabolic alkalosis, severe hypokalemia and inapropiate kaliuresis and a secundary cause of hypertension was considered. After a comprehensive workout and several sequential clinical assays, it was concluded that this state of hyporeninemic hyperaldosteronism was a case of the rare genetic disease known as a glucocorticoid-remediable hyperaldosteronism. As far as we know, this is the first case reported in El Salvador and Central America. A review of the subject has been made.

 hipertensión refractaria hiperaldosteronismo refractary hypertension hyperaldosteronism Bakris GL Williams M Dworkin L Elliott WJ Epstein M Toto R Preserving renal function in adults with hypertension and diabetes: a consensus approach Am J Kidney Dis 2000 36 Vidt DG Pathogenesis and treatment of resistant hypertension Minerva Med 2003 A ug Calhoun DA Jones D Textor S Goff DC Murphy TP Toto RD Resistant Hypertension: Diagnosis, Evaluation and Treatment. A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research Hypertension 2008 51 Denolle T Hanon O Mounier-Vehier C Marquand A Fauvel JP Laurent P What tests should be conducted for secondary arterial hypertension in hypertensive patients resistant to treatment? Arch Mal Coeur Vaiss 2000 A ug 93 8 Mosso L Carvajal C González A Barraza A Ávila F Primary Aldosteronism and Hypertensive Disease Hypertension 2003 42 Fardella CE Montero J Mosso L Hypertension and mineralocorticoids. Usefulness of renin and aldosterone measurements Rev Med Chil 1999 M ay 127 5 Pratt JH Low-renin hypertension: more common than we think? Cardiol Rev 2000 8 4 Su YR Menon AG Epithelial sodium channels and hypertension Drug Metab Dispos 2001 A pr 29 4 Pt 2 Luft FC Molecular genetics of salt-sensitivity hypertension Drug Metabolism and Disposition 2001 29 4 Part 2 Garovic VD Hilliard AA Turner ST Monogenic forms of low renin hipertensión Nat Clin Pract Nephrol 2006 2 11 Toka HR Luft FC Monogenic forms of human hypertension Semin Nephrol 2002 M ar 22 2 Ferrari P Genetics of the mineralocorticoid system in primary hypertension Curr Hypertens Rep 2002 F eb 4 1 Lifton RP Dluhy RG Powers M Hereditary hypertension cause by chimeric gene duplications and ectopic expression of aldosterone synthase Nat Genet 1992 2 Ferrari P Bianchetti M Frey FJ Juvenile hypertension, the role of genetically altered steroid metabolism Horm Res 2001 55 5 Bahr V Oelkers W Diederich S Monogenic hypertension Med Klin 2003 A pr 98 4 McMahon GT Dluhy RG Glucocorticoid-remediable aldosteronism Arq Bras Endocrinol Metab 2004 48 5 Geller DS Farhi A Pinkerton N Fradley M Moritz M Spitzer A Activating Mineralocorticoid Receptor Mutation in Hypertension Exacerbated by Pregnancy Science 7 Ju ly 2 289 5476 Bravo EL What to do when potassium is low or high Diagnosis 1988 10 Fardella CE Pinto M Mosso L Gómez-Sánchez C Jalil J Montero J Genetic Study of Patients with Dexamethasone-Supressible Aldosteronism without the Chimeric CYP11B1/CYP11B2 Gene J Clin Endocrinol Metab 2001 86 Fardella CE Rodríguez H Hum DW Mellon SH Miller WL Artificial mutation in P450c11AS (aldosterone synthase) can increase enzymatic activity: a model for low-renin hypertension? J Clin Endocrinol Metab 1995 80
S1409-414220070003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000300006 Tumor atrial izquierdo, fístula coronaria y arritmias Bogantes Pereira Eric Chavarría Víquez Jorge ,Hospital México Costa Rica 09 2007 2007 9 29 33

Se presenta el caso de un paciente de 66 años con varios hallazgos patológicos cardiacos muy peculiares: tumor atrial, fibrilación atrial, bloqueo atrioventricular de alto grado intermitente y la presencia de una fístula coronaria que emerge de la arteria coronaria derecha.

The case of a 66 years old male with several peculiar cardiac pathological findings is presented: atrial mass, atrial fibrillation, high degree intermittent atrioventricular block and the presence of a coronary fistula emerging from the right coronary artery.

 Mixoma fístula coronaria bloqueo atrioventricular Cardiac myxomas Coronary artery fistula AV block Burke A Jeudy J Cardiac Tumours: an update Heart 2008 Sabatine MS Colucci WS Schoen FJ Braunwald E Zipes D Libby M Bonow R Tumores primarios del corazón Braunwald’s Cardiología. El libro de medicina cardiovascular Braunwald’s Cardiología. El libro de medicina cardiovascular 2004 Editorial Marban Reynen K Cardiac Myxomas N Eng J Med 1995 333 Wold EL Lie JT Cardiac Myxomas a clinicopathologic profile. Review Article Am J Pathol 1980 101 Regland MM Tak T Detection of Atypical Right Atrial Myxoma by Echocardiography Cardiology in review 2006 14 Abdelmoneim S Mookadam F Moustafa S Holmes D Coronary Artery Fistula with Anomalous coronary artery origin J Am Soc. Echocardiogr 2007 20 Angelini P Velasco JA Flamm S Coronary anomalies: incidence, pathophysiology and clinical relevance Circulation 2002 105 Marelli R Drago A Basso G Bravo F Torrijos R Tumores primarios cardiacos, Aspectos Clínicos y Tratamiento Rev Fed Arg Cardiol 2002 31 Peters P Reinhart S The echocardiographic evaluation of intracardiac masses: a review J Am Soc Echocardiogr 2006 19 Jorens PG Van Den Heuvel PA Van Cauwelaert PA Parizel GA Myxoma with a left-to-left shunt and fistula Chest 1989 96 Mirrasouli M Tak T The Role of Echocardiography in Diagnosing Space-Occupying Lesions of the Heart Clinical Medicine and Research 2006 4 1 Nakamura Y Yutani Ch Imakita M Ishibashi-Ueda H Nisihda N Iida K A Huge Coronary Aneurysm Resulting from a Coronary Artery-to-Left Ventricle Fistula Intern Med 1998 37 Reynen K Kockeritz U Strasser R.H Metastases to the heart Annals of Oncology 2004 15 Liu HY Panidis J Soffer Dreifus LS Echocardiographic diagnosis of intracardiac myxomas. Present Status Chest 1983 84 Yu K Liu Y Wang H Hu s Long C Epidemiological and pathological characteristics of cardiac tumors: a clinical study of 242 cases Interactive Cardiovascular and Thoracic Surgery 2007 6 Barlis P Calafiore P O´Donnell D Angine from a right coronary artery to right atrial fistula Heart 2006 92 Zen K Asai T Tatsukawa H Matsubara H Coronary artery-left atrial fistula caused by feeding artery rupture in cardiac myxoma Heart 2007 93
S1409-414220070003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000300007 Fístula carotídea-yugular secundaria a colocación de vía central Hernández-Matamoros Harol Padilla-Cuadra Juan Ignacio Hernández de Mezerville Viviana ,Hospital R. A. Calderón Guardia ,Hospital R. A. Calderón Guardia ,Hospital R. A. Calderón Guardia 09 2007 2007 9 35 37

La colocación de una vía central yugular interna no está exenta de complicaciones. Una infrecuente es la formación de una fístula arterio-venosa entre la vena yugular y la arteria carótida. Este diagnóstico debe sospecharse en pacientes que después del procedimiento desarrollan un frémito en el sitio de la punción y el tratamiento puede ser quirúrgico o endovascular. Existen medidas de prevención para evitar la punción simultánea de la arteria y la vena durante el procedimiento, tales como es el uso de la ecografía para guiar la canalización de la vena. Se reporta el caso de un paciente que desarrolló una fístula carotídea-yugular luego de la colocación de una vía yugular interna.

Carotid-jugular fistula secondary to central vein catheterization The internal jugular vein access to central venous catheterization is not free of complications. One rare complication due to arterial puncture is the formation of an arteriovenous fistula, between the jugular vein and the carotid artery. The diagnosis must be suspected in a patient who develops local thrill after the procedure and the treatment can be either surgical or endovascular. There are some measures to avoid simultaneous venous and arterial puncture and prevent this complication such as the use of ultrasound as a guide. We report a case of carotid jugular fistula after right jugular catheterization.

 Fístula carotídea yugular cateterización vía central Carotid-jugular fistula central vein catheterization Polderman KH Girbes AR Central venous catheter use: mechanical complications Intensive Care Med 2002 28 Hernández MA Álvarez C Pérez MA Complicaciones de la canalización de una vía venosa central Rev Clin Esp 2006 206 1 McGee DC Gould MK Preventing complications of central venous catheterization N Engl J Med 2003 348 Taylor R Palagiri A Central Venous Catheterization Crit Care Med 2007 36 Kusminski R Complications of Central Venous Catheterization J Am Coll Surg 2007 204 4 Droll KP Lossing AHG Carotid-jugular Arteriovenous Fistula: Case Report of an Iatrogenic Complication Following Internal Jugular Vein Catheterization J Clin Anesthesia 2004 16 El-Shahawy MA Khilnani H Carotid -Jugular arteriovenous fistula: a complication of temporary hemodialysis catheter Am J Nephrol 1995 15 Ezri T Szmuk P Cohen Y Simon D Mavor E Katz J Geva D Carotid Artery - internal jugular fistula: a complication of internal jugular vein catheterization J Cardiothorac Vasc Anesth 2001 15 Gobeil F Couture P Girard D Plante R Carotid Artery internal Jugular fistula: Another complication following pulmonary artery catheterization via the internal jugular venous route Anesthesiology 1994 80 Sharma VK Pereira AW Ong BK Rathakrishnan R Chan BP Teoh HL External carotid artery-internal jugular vein fistula a complication of internal jugular cannulation Circulation 2006 113 Sato O Tada Y Sudo K Ueno A Nobori M Idezuki Y Arteriovenous Fistula Following Central Venous Catheterization Arch Surg 1986 121 Garcia E Wijdicks EFM Younge BR Neurologic Complication associated with Internal Jugular vein cannulation in critically ill patients: a prospective study Neurology 1994 44 Vera M Quintana L Blasco J Real M Macho JM Treatment with the placement of carotid stent of jugular-carotid fistula after the insertion of hemodialysis catheter Nefrologia 2005 25 5 Brawazzer MA Al-Jared MS Al-Brekeit KA Al- Harbi WM The use of endovascular stent-grafts for the treatment of common carotid-internal jugular fistula Saudi Med J 2006 27 1 Guglielmi G Viñuela F Duckwiler G Dion J Stocker A High-flow, Small-Hole Arteriovenous Fistula: Treatment with electrodetachable coils Am J Neuroradiol 1995 16 2 Sulek CA Grovenstein N Blackshear RH Weiss L Head rotation during internal jugular vein cannulation and the risk of carotid artery puncture Anesth Analg 1996 82 Denys BG Uretsky BF Reddy PSA Ultrasound -assisted cannulation of the internal jugular vein: a prospective comparison to the extend landmark-guided technique Circulation 1993 87 Keenan SP Use of the ultrasound to place central lines J Crit Care 2002 17
S1409-414220070003 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422007000300008 Electrocardiograma del mes Araya Gómez Dra. Vivien ,Centro Cardiológico Integral 09 2007 2007 9 39 40