[HSF] Tetralogy of Fallot

[Nasser F. Abou'Seada]

Dear Prasanna 
what is the shoulder of the heart ??

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 1:15 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Tetralogy of Fallot
> 
> If you do not have access to a pulmonary homograft then you could place
> a bioprosthesis high up at the "shoulder" of the heart.
> Prasanna
> prasannasimha wrote:
> > Dear Daniel, she cannot have the cake and eat it too. She cannot
> > receive a BT shunt because of her AR
> > I think a reasonable immediate palliation would be to do a balloon
> > pulmonary valvotomy by your cardiologists. This would allow some
> > antegrade flow (she cannot develop infundibular spasm at this age),
> > reduce her RV hypertension and then I would reassess her after 2-3
> > months to see if her RV function has improved. If it improves then she
> > would need an AVR and total correction with a either RVOT release or
> > if a transannular patch will be required she needs to have a pulmonary
> > homograft placed.
> > She would also benefit with a phlebotomy in view of her high Hematocrit.
> > What is her pulmonary valve size and is her branch PA's good ?
> > I am worried about her varices too. Why has she got them ???
> > I have a 50 year old lady whom I will be operating for TOF after the
> > conference and I have told them that they must be ready for a
> > homograft in the pulmonary position if I need to use a TAP.
> > Prasanna
> > Dr. Daniel Bigalli wrote:
> >> 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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