[Pulmonary hypertension in hereditary haemorrhagic teleangiectasia (Rendu-Osler-Weber disease). Progression over 10 years].
METHODS
10 years ago a now 49-year-old woman with Render-Osler-Weber disease showed unspecific symptoms of nausea, and general unwellness. Pulmonary manifestation of the disease was accompanied by pulmonary hypertension.


METHODS
Teleangiectasia of the tongue and pharynx as well as of the mucosa of mouth and nose were observed. Fixed-splitting of the second heart sound with accentuated pulmonary component and a 2/6 systolic murmur over the tricuspid valve were heard. In addition, a murmur was heard dorsal over the right lung's lower lobe. Apart from minor oedema of both ankles, the physical status was not remarkable. Echocardiography showed dilatation of the right ventricle and a minor regurgitation of the tricuspid valve. The computed tomography showed dilatation of the pulmonary arteries as well as an arteriovenous malformation in the right lower lobe. Right-heart catheterisation revealed elevated pulmonary pressure. THERAPY AND FOLLOW-UP: Initial treatment with a calcium channel blocker proved insufficient and was changed to inhalative, and later to oral prostanoids. Under this treatment the cardiopulmonary state was stabilised, but episodes of epistaxis were increased. Two years after readjustment of the medication to a dual endothelin receptor antagonist, the cardiopulmonary state remains stable without significant haemorrhagic complications.


CONCLUSIONS
Prostanoid treatment in patients with Render-Osler-Weber disease and additional pulmonary hypertension can lead to an increased risk of haemorrhagic complications. Treatment with newer medications, such as endothelin receptor antagonists, seems indicated as successfully illustrated in our case.
Schlag
K
K
Klinik für Innere Medizin B, Ernst-Moritz-Arndt-Universität, Greifswald.
Opitz
C
C
Wensel
R
R
Felix
S
S
Ewert
R
R
D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000077300:Bosentan; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D065128:Endothelin Receptor Antagonists; D004844:Epistaxis / Q000139:chemically induced; D011464:Epoprostenol / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016285:Iloprost / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use; D010375:Pedigree; D010644:Phenprocoumon / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use*; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D017211:Treatment Failure; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D065128:Endothelin Receptor Antagonists; D011725:Pyridines; D013449:Sulfonamides; D014665:Vasodilator Agents; C048081:beraprost; D005665:Furosemide; C038068:cicletanine; D011464:Epoprostenol; D009543:Nifedipine; D016285:Iloprost; D010644:Phenprocoumon; D000077300:Bosentan