[HSF] Tetralogy of Fallot

[erdinç naseri]

DEAR dr.Bigalli,
1.pulmonary edema is not seen in patients with uncorrected TOF 2.patients 
with longstanding arterial hypoxia develope myocardial fibrosis leading to 
biventricular failure.3.IMHO surgery is of no value in this particular caes.
erdinc naseri


>From: "Dr. Daniel Bigalli" <biga at multitel.com.uy>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: [HSF] Tetralogy of Fallot
>Date: Sat, 20 Jan 2007 13:48:12 -0300
>
>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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