[HSF] Tetralogy of Fallot

[Nasser F. Abou'Seada]

Yes prasanna .... I have seen a Semb and a Brock Knife

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Saturday, January 20, 2007 10:29 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Tetralogy of Fallot
> 
> The Brock procedure has one problem - it is pretty blind. A catheter
> based balloon would decrease the RVOT gradient while the residual
> subvalvar PS would prevent over flooding. I have seen palliative
> ballooning of the valve done and it does provide significant relief till
> the full procedure can be done.Has anyone seen a Semb and a Brock Knife
> ? I have.
> Prasanna
> jbflegejr at aol.com wrote:
> > This patient sounds like a good candidate for the Brock procedure
> > which probably has not been performed in the U.S. for the past 40
> > years and maybe no place else either, but that does not negate its
> > value in selected cases, and where the principal obstruction is of the
> > pulmonary valve which you describe, it should be considered. The goal
> > is to reduce the pulmonary outflow obstruction enough to allow the
> > pulmonary flow to approximate the systemic flow and produce what is
> > sometimes termed "acyanotic tetralogy". In London and later in Iowa
> > City we did this with Hegar dilators passed through the wall of the
> > right ventricle and dilated the valve progressively until the
> > pulmonary artery pressures were around 30 to 40 mmHg and the arterial
> > oxygen saturations were above 90%. A left anterior thoracotomy or a
> > median sternotomy provides exposure but the sternotomy would be best
> > as more options would be available to you. It is important not to
> > overdo it and flood the lungs. Infundibular obstruction can be
> > relieved using a Brock punch through the right ventricule but this may
> > be difficult in the older adult and probably should not be done by
> > someone without a lot of experience. From your description, it sounds
> > predominately valvular. One might be tempted to try a PCI with a
> > dilating balloon which might be disastrous since the secret to success
> > is to do just enough and not too much. A systemic pulmonary shunt
> > might be considered but cannot achieve nearly as high arterial oxygen
> > saturation as the Brock operation and increases the cardiac work more.
> > Brock and others wrote about this in 50's and 60's. John Flege
> >
> > -----Original Message-----
> > From: biga at multitel.com.uy
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Sat, 20 Jan 2007 11:48 AM
> > Subject: [HSF] Tetralogy of Fallot
> >
> >   Dear members:
> >
> > I would like to know your opinions and treatment about this case.
> >
> >
> >
> > 55 year old woman with an unoperated Tetralogy of Fallot. This year
> > she has been
> > Hospitalized because of HF.
> >
> > She  refuses the definit surgery but does not a palliative procedure
> > of lower
> > risk.
> >
> > The following describes her clinical situation and the last
> > echocardiogram :
> > Age : 55. White race. Works in an office. She describes excercice
> > disphnea,
> > functional class II. She has had hospitalized 3 times this year
> > because HF (not
> > acute lung edema).
> >
> > She has elements of systemic venous hypertension as low limbs edema,
> > yugular and
> > high limbs venous ingurgitation. She has universal cyanosis and
> > elements of
> > cronic hypoxemia.
> >
> >
> >
> > Last transthoracic echocardiography  showed : 50% overriding of the
> > aorta, wide
> > ventricular septal defect with few bidireccional flow (probably
> > because of equal
> > pressures), left ventricle hypertrophy 14 mm, diastolic diameter of 56
> > mm, right
> > ventricle hipertrophy, bi-atrial dilation, ejection fraction of 40%,
> > pulmonic
> > valve with domo movement, maximum gradient of 100 mmHg at pulmonary
> > valve,
> > hypertrophy of infundibular area, severe aortic regurgitation,
> > dilation of
> > inferior vena cava. There is no angiography of pulmonar vessels.
> >
> >
> >
> > She also has comorbidities : grade I esophagus varices, inferior
> > myocardial
> > infarction in 2002 by occlusion of the right coronary.
> >
> > Laboratory shows an hemoglobin of 22 g/dl, hematocrit of 64%, 123000
> > platelets,
> > creatinin of 1.3 g/dl.
> >
> > Arterial gasometry PaO2 of 40 mmHg while compensated.
> >
> >
> >
> > Best regards
> >
> >
> >
> > Dr. Daniel Bigalli
> >
> > Montevideo-Uruguay
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