title: Severe left ventricular dysfunction secondary to primary pulmonary hypertension: bridging therapy with bosentan before lung transplantation.
abstract: When right ventricular failure develops secondary to primary pulmonary hypertension, right-left ventricular interaction may lead to severe impairment of left ventricular function. In such cases, many experts favor combined heart-lung transplantation by fear that the left ventricle may not recover after transplantation of the lungs alone. We report a case of primary pulmonary hypertension with severely diminished right and left ventricular function. The patient was rendered amenable to isolated pulmonary transplantation with the endothelin-receptor antagonist bosentan. The medication improved right and left ventricular function to the point that heart transplantation no longer appeared necessary. After double-lung transplantation the patient's cardiac function made a full recovery. This approach might be particularly welcome considering both the current donor organ shortage and the limited number of surgical teams with expertise in heart-lung transplantation.
authors.affiliation: Division of Pneumology, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Brauchlin
authors.forename: Paola M
authors.initials: PM
authors.lastname: Soccal
authors.forename: Thierry
authors.initials: T
authors.lastname: Rochat
authors.forename: Anastase
authors.initials: A
authors.lastname: Spiliopoulos
authors.forename: Laurent P
authors.initials: LP
authors.lastname: Nicod
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Trindade
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000077300:Bosentan; D003131:Combined Modality Therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000628:therapy*; D016040:Lung Transplantation; D008297:Male; D012720:Severity of Illness Index; D013449:Sulfonamides / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D018497:Ventricular Dysfunction, Right / Q000209:etiology*
chemical_list: D000959:Antihypertensive Agents; D013449:Sulfonamides; D000077300:Bosentan