[HSF] Tetralogy of Fallot

[Nasser F. Abou'Seada]

Dear Erdinc 
I quite agree with your first comment. Your second comment would go against
a total correction. would you agree that a small procedure to increase PBF
and PaO2 would merit intervention ?

BTW ,,.. I'm glad we share the same name .. without an "i" .. 
Kindest regards 

NFA

> From: 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