title: Successful up-front combination therapy in a patient with idiopathic pulmonary hypertension and patent foramen ovale: an alternative to epoprostenol therapy?
abstract: Pulmonary arterial hypertension (PAH) is a life-threatening disease of the pulmonary arterioles, which, in the absence of effective therapy, progresses rapidly to right heart failure and death. Opening of a patent foramen ovale (PFO) is common in patients with severe pulmonary hypertension (PH), resulting in resistive hypoxemia. We report the case of a 40-year-old woman with idiopathic pulmonary hypertension (iPAH) in New York Heart Association (NYHA) class III to IV, who was admitted in the intensive care unit with hemodynamic compromise and severe hypoxemia due to right-to-left shunt throughout a PFO. Combination therapy initially with inhaled iloprost and sildenafil, and then addition of an endothelin A receptor-selective antagonist (sitaxsentan), resulted in impressive improvement in oxygenation with reversal of the right-to-left shunt and marked improvement in functional class of the patient.
authors.affiliation: Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Georgia G
authors.initials: GG
authors.lastname: Pitsiou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Chavouzis
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Nakou
authors.forename: Afroditi K
authors.initials: AK
authors.lastname: Boutou
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Argyropoulou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Stanopoulos
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D065130:Endothelin A Receptor Antagonists; D011464:Epoprostenol / Q000627:therapeutic use*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016285:Iloprost / Q000627:therapeutic use*; D007555:Isoxazoles / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D065130:Endothelin A Receptor Antagonists; D007555:Isoxazoles; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D013876:Thiophenes; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D011464:Epoprostenol; C106276:sitaxsentan; D016285:Iloprost