Combination Therapy With Sildenafil and Bosentan Reverts Severe Pulmonary Hypertension and Allows Heart Transplantation: Case Report

Mogollón, María V.; Lage, E.; Cabezón, Soledad; Hinojosa, R.; Ballesteros, Sara; Aranda, Alfonso; Sobrino, José Manuel; Ordóñez, Antonio

doi:10.1016/j.transproceed.2006.08.074

Cited by 19 publications

(16 citation statements)

References 8 publications

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“…Correction of left-sided lesions often suffices, but in cases in which pulmonary hypertension persists, oral pulmonary vasodilators such as sildenafil and bosentan may be helpful in promoting reverse remodeling of the right ventricle [17].…”

Section: Implications For Surgical Therapymentioning

confidence: 99%

Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery

Anyanwu¹,

Chikwe²,

Adams

2008

Curr Cardiol Rep

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Secondary or functional tricuspid regurgitation occurring late after mitral valve surgery is associated with high morbidity and mortality. In this article, we review the pathophysiology of secondary tricuspid regurgitation and the evidence supporting the use of tricuspid valve annuloplasty for preventing and treating secondary tricuspid regurgitation. Liberal application of tricuspid valve annuloplasty is recommended to prevent progression of secondary regurgitation, as contrary to widely held opinion, fixing the left-sided valve dysfunction often does not resolve secondary tricuspid valve dysfunction. Based on existing literature, assessing the tricuspid valve annular dimensions can be recommended as part of all mitral valve operations, and annuloplasty strongly considered in patients with tricuspid annular dilatation or moderate to severe tricuspid regurgitation.

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Section: Implications For Surgical Therapymentioning

confidence: 99%

Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery

Anyanwu¹,

Chikwe²,

Adams

2008

Curr Cardiol Rep

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“…30 Several case reports exist in which long term oral sildenafil therapy decreased PVR in a patient with an elevated PCWP to a transplantable level. 31–32 …”

Section: Introductionmentioning

confidence: 99%

PDE5A Inhibitor Treatment of Persistent Pulmonary Hypertension After Mechanical Circulatory Support

Tedford

Hemnes

Russell

et al. 2008

Circ: Heart Failure

173

107

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BACKGROUND Pulmonary hypertension (PH) secondary to left heart failure portends a poor prognosis and is a relative contraindication to heart transplantation at many centers. We tested the hypothesis that when PH persists after adequate left ventricle (LV) unloading via recent left ventricular assist device (LVAD) therapy, phosphodiesterase type 5A (PDE5A) inhibition would decrease PH in this population. METHODS AND RESULTS We performed an open-label clinical trial using control patients not receiving therapy. Between 1999 and 2007, one hundred thirty-eight consecutive patients undergoing cardiac transplantation evaluation with advanced left ventricular dysfunction, an elevated pulmonary capillary wedge pressure (PCWP), and PH (defined by a pulmonary vascular resistance (PVR) > 3 Woods Units), were treated with LVAD therapy. Fifty-eight of these patients reduced their PCWP to a value < 15 mmHg (11.8 +/− 2.0 mmHg from baseline 23.2 +/− 6.2 mmHg) one to two weeks after LVAD implantation, but despite this improvement, the PVR of these patients was only minimally affected (5.65 +/−3.00 to 5.39 +/− 1.78 Wood Units). Twenty-six consecutive patients from this group with persistently elevated PVR were started on oral PDE5A inhibition with sildenafil and titrated to an average of dose of 51.9 mg by mouth three times per day. The average PVR in the sildenafil treated group fell from 5.87 +/− 1.93 to 2.96 +/− 0.92 Wood Units (P<0.001) and the mean pulmonary artery pressure (mPAP) fell from 36.5 +/− 8.6 to 24.3 +/− 3.6mmHg (P<0.0001) and was significantly lower when compared to the thirty-two LVAD recipients not receiving sildenafil at weeks 12–15 after the initial post LVAD hemodynamic measurements (13 to 17 weeks post LVAD implantation). In addition, hemodynamic measurements of right ventricular (RV) function in sildenafil treated patients was also improved compared with patients not receiving sildenafil. CONCLUSIONS In patients with persistent PH after recent LVAD placement, PDE5A inhibition in this open label trial resulted in a significant decrease in PVR as compared with control patients.

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“…New approaches based on treatment of heart transplant candidates with pulmonary hypertension have increased the number of patients suitable for placement on the waiting list and additionally it has shown beneficial effect on survival after HTx. Recently, sildenafil, a fosfodiesterase-5-inhibitor and traditional drug for erectile dysfunction treatment, has been successfully introduced into the algorithms for testing and treatment of pre-transplant pulmonary hypertension [14][15][16][17] . Elevated PVR in heart transplant candidates can also be reduced using a left ventricular assist device.…”

Section: Discussionmentioning

confidence: 99%

Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

Bedáňová

Orban²,

Vrsanský³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims.To determine the effect of pre-existing pulmonary hypertension (PHT) on early hemodynamics, morbidity and mortality after heart transplantation (HTx). Methods. Data were prospectively collected from 149 patients, who underwent HTx between January 2000 and December 2007. The subjects were divided into 3 groups: Group A (n=84) without PTH, group B (n=50) with mild to moderate PTH and group C (n=15) with severe PTH. We studied hemodynamic profile, tricuspid valve regurgitation (TR), incidence of acute cellular rejections (AR), infections, duration of hospitalization, 30-day mortality and a longterm survival. Results. Baseline characteristics were similar in all groups. Using vasodilator treatment PVR was successfully brought down to normal range 2.5 ± 0.6 Wood' units (WU) on the day 1 following the surgery in all groups. Over 80% of patients were treated in Group C, 32% in Group A and 46% in Group B. There was no significant difference in the severity of TR among the 3 groups early after HTx (severe TR was observed in 46%, 54%, 33%, respectively). There was no significant difference in incidence of AR (G ≥ 2 Banff classification) (23%, 23%, 33%, respectively), infections (28%, 32%, 33%, respectively) or duration of hospitalization (30, 30, 28 days, respectively). There was no correlation between pre-transplant PHT and 30-day mortality or a long-term survival. Conclusions. In our cohort, PHT dropped very quickly after HTx, and was not associated with acute right heart failure following the surgery. Reversible PTH does not have a negative impact on short-or long-term survival after HTx.

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Combination Therapy With Sildenafil and Bosentan Reverts Severe Pulmonary Hypertension and Allows Heart Transplantation: Case Report

Cited by 19 publications

References 8 publications

Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery

Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery

PDE5A Inhibitor Treatment of Persistent Pulmonary Hypertension After Mechanical Circulatory Support

Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

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