Patients with pulmonary arterial hypertension (PAH) may develop large
pulmonary artery aneurysms (PAA) which may be complicated by rupture,
dissection or intravascular thrombus formation. These patients were
traditionally considered for heart-lung transplantation but more
recently, there have been reports of successful lung transplantation
with reconstruction of the pulmonary artery (PA). We present two
patients who underwent successful transplantation for PAH with giant
PAA. One patient had end stage PAH and right pulmonary artery atresia
complicated by a giant main PAA. This patient underwent bilateral
sequential lung transplantation with concurrent pulmonary artery
reconstruction. Another patient had end stage PAH with giant PAA on a
background of D-transposition of the great arteries who had a Mustard
repair at 9 months of age. This patient underwent heart-lung
transplantation. Both heart-lung transplantation and lung
transplantation with reconstruction of the pulmonary should be
considered as a treatment option for patients with PAH with PAA.
<b><i>Introduction:</i></b> Iron deficiency is a common condition, especially among patients with kidney and heart failure and inflammatory bowel disease. Intravenous iron is the preferred method of treatment in these patients, but it usually requires prolonged iron polymaltose infusions or multiple administrations of alternative preparations. The aim of the study was to confirm the safety and patient acceptance of ultrarapid iron polymaltose infusions as an alternative to slower treatments and ferric carboxymaltose. <b><i>Method:</i></b> An open-label, phase 4 safety study was conducted at a tertiary hospital, with consenting participants diagnosed with iron deficiency and requiring iron polymaltose up to 1,500 mg receiving the infusion over 15 min. The acute adverse event (AE) rates and their severities were compared to historical controls of 1- and 4-h iron polymaltose infusions from a retrospective study of 648 patients from the same study site. Delayed AEs as well as participant infusion acceptability were also studied. <b><i>Results:</i></b> Three hundred participants over a 2-year period received ultrarapid infusions of iron polymaltose with an acute AE rate of 18.7% and severe AE rate of 1.0%. The total and mild infusion AE rates were higher compared to those of slower infusions (<i>p</i> < 0.001), but comparable for moderate and severe AEs. Delayed reactions occurred in 12.5% of participants, with over 95% of them preferring repeat ultrarapid infusions if required again. <b><i>Conclusion:</i></b> Iron polymaltose can be safely infused at ultrarapid rates when compared to slower infusions, with similar safety to ferric carboxymaltose, offering greater convenience for patients and reduced healthcare costs.
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