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#26 De: Alejandro Jose Lopez Magallon <alejandrolopez@infosel.net.mx>
Enviado: Martes 8 de Febrero de 2000 23:39
Asunto: Re: Preguntas al Foro/Re: Questions to the Forum
Sponsored by: Bayer SA
La adenosina es una droga de "alto impacto", en el sentido de que es muy efectiva para terminar los episodios de TSV, con muy pocos efectos  secundarios. Es posible aplicarla en multiples ocasiones si los cuadros recurren con frecuencia, como en algunos pacientes dificiles. Es indispensable hoy en dia en todo departamento de Urgencias pediatricas.
Debe aplicarse en bolo intravenoso seguido inmediatamente por otro de ~5 cc de solucion salina, ya que su vida media es de ~ 4 segundos. La infusion intraosea es una via inadecuada para administrarla.

Adenosine is a "high impact" drug, in the sense that it is very effective to end the episodes of supraventricular paroxysmal tachycardia, with very little secondary effects. It is possible to apply it in several occasions if the manifestations recur frequently, as well as in some difficult patients. Nowadays, it is essential in all departments of Pediatric Urgencies. It must be applied in an intravenous bolus, immediately followed by another of ~5cc of saline solution, since its mean life is ~4 seconds. The intraosseous infusion is not a proper via to administer it.
Dr. Alejandro Lopez
Hospital Central Militar
Mexico

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#27 De: Carlos Viscuso <caviscuso@infovia.com.ar>
Enviado: Jueves 10 de Febrero de 2000 21:07
Asunto: Tetralogia de Fallot y embarazo?/Tetralogy of Fallot and pregnancy?
Sponsored by: Productos Roche
Queridos colegas:
Les escribo para presentarles un caso complejo que de no poder asesorarme, al menos podran aconsejarme.
Se trata de una paciente de 20 anios portadora de Tetralogia de Fallot cianotica completa a quien a los 6 anios de edad se le practico una cirugia paliativa de Blalock Tausig. Hace 4 anios, quedo embarazada deteriorando su clase funcional por crisis hipoxicas e hipercianoticas que obligo, en el ultimo trimestre del embarazo a practicar cesarea de urgencia. Sin embargo, persistio severamente sintomatica hasta la fecha que consulta nuevamente por embarazo de ocho semanas.
Que se deberia hacer en forma inmediata con esta paciente a vuestro criterio en este momento, ya  que no quedan dudas que esta indicada la cirugia correctiva total.
Les agradeceria me enviaran su opinion.
Aguardando su respuesta, aprovecho la oportunidad para saludarlos atte

Dear colleagues:
I am writing to you, to present a complex case about which if you may not inform me, at least you may advise me.
This is a 20-year-old patient, carrier of complete cyanotic Fallot Tetralogy, in whom a Blalock Tausig palliative surgery was performed when she was 6. Four years ago, she got pregnant, impairing her functional class due to hypoxic and hypercyanotic crises that forced us to perform on her an urgent cesarean in the last trimester of pregnancy. However, it persisted severely symptomatic until the date when she consulted again due to an eight-week pregnancy.
What should be immediately done with this patient according to your criteria in this moment, since there is no doubt that total corrective surgery is indicated.
I would be grateful if you could send me your opinions.
I remain waiting for your replies, and I take advantage of the opportunity to send you my regards.
Dr. Carlos Viscuso

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#28 De: Alejandro Jose Lopez Magallon <alejandrolopez@infosel.net.mx>
Enviado: Domingo 13 de Febrero de 2000 10:19
Asunto: Re: Tetralogia de Fallot y embarazo?/Re: Tetralogy of Fallot and pregnancy?
Sponsored by: Deutsche Bank
En relacion a esta paciente, me parece que se presenta como un problema aun mas dificil de manejar en este segundo embarazo pues ya habia  deterioro en su clase funcional antes del mismo (aun cuando no se proporcionan elementos mas especificos de valoracion cardiovascular, clase funcional, funcion del ventriculo derecho, etc.). Debera valorarse su situacion hemodinamica con sumo cuidado para decidir si es realmente factible el querer llevar este embarazo a termino. Si los riesgos para la vida de la madre son excesivos, debera considerarse el recomendar terminar el embarazo, y despues cirugia correctiva.

In regard to this patient, it seems to me that she presents as a problem still very difficult to manage in this second pregnancy, since there was impairing already in her functional class before it (even when more specific elements for cardiovascular assessment, functional class, right ventricle function, etc. are not provided). Her hemodynamic situation must be assessed with extreme care to decide if it is really feasible to carry out this pregnancy to the end. If the risks for the life of the mother are excessive, the recommendation to end the pregnancy should be considered, and afterwards corrective surgery.
Dr. Alejandro Lopez
Hospital Central Militar
Mexico

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#29 De: Diego Esandi <esandi@arnet.com.ar>
Enviado: Martes 15 de Febrero de 2000 00:31
Asunto: Tetralogia de fallot y embarazo/Tetralogy of Fallot and pregnancy
Sponsored by: Laboratorios Gador
Estimado amigo:
Creo que en primer lugar es necesario un cateterismo cardiaco para determinar con total exactitud el flujo pulmonar y la presion pulmonar.
No es tan infrecuente que una Tetralogia de Fallot que llega a la adultez y requirio una anastomosis a los 6 años, pueda haber desarrollado hipertension pulmonar.
En particular es necesario el grado de colaterales aorto pulmonares y el tipo de anastomosis realizada a los seis anios, su tamanio y su estado actual.
Luego de esta informacion se podria proceder a analizar la indiacion mas apropiada
Atte.

Dear friend:
I think that first, a cardiac catheterization is necessary to determine with total accuracy pulmonary flux and pulmonary pressure. It is not so rare for a Tetralogy of Fallot that reaches adulthood and that required anastomosis at 6 years, could have developed a pulmonary hypertension. The degree of aorto-pulmonary collateral vessels is particularly necessary, as well as the type of anastomosis carried out at six years, its size, and its current state.
After this information, we could proceed to assess the most appropriate indication.
Sincerely,
Dr Diego Esandi
Caridologo Pediatra
Neuquen, argentina

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