Severe left ventricular dysfunction secondary to primary pulmonary hypertension: bridging therapy with bosentan before lung transplantation.
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.
Brauchlin
Andreas E
AE
Division of Pneumology, University Hospital of Geneva, Geneva, Switzerland.
Soccal
Paola M
PM
Rochat
Thierry
T
Spiliopoulos
Anastase
A
Nicod
Laurent P
LP
Trindade
Pedro T
PT
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*
D000959:Antihypertensive Agents; D013449:Sulfonamides; D000077300:Bosentan