title: Unexpected pulmonary hypertensive crisis after surgery for ocular malignant melanoma.
abstract: OBJECTIVE
  To report a case of unexpected pulmonary hypertensive crisis caused by endothelin release from melanoma cells after surgery for choroidal melanoma.
  
  
  METHODS
  A 56-year-old man suddenly developed dyspnea after resection of choroidal melanoma. Worsening hypoxia required intensive treatment, including percutaneous cardiopulmonary support, after which a series of tests were immediately performed. The tentative diagnosis was idiopathic pulmonary arterial hypertension.
  
  
  RESULTS
  Previous studies noted a significant association between melanoma and endothelin (ET)-1. We hypothesized that a substantial amount of ET-1 had been released from malignant melanoma cells during resection, thus triggering the pulmonary hypertensive crisis in our patient. The patient fully recovered after intensive treatment and administration of the endothelin receptor antagonist bosentan.
  
  
  CONCLUSIONS
  The success of bosentan treatment, along with the extremely high level of ET-1 on pathologic analysis, confirmed our hypothesis regarding the increase in plasma ET-1 level.
authors.affiliation: Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan. Electronic address: kaorina@oha.toho-u.ac.jp.
authors.forename: Kaori
authors.initials: K
authors.lastname: Sato
authors.affiliation: Division of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Saji
authors.affiliation: Division of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Division of Pathology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
mesh_terms: D001794:Blood Pressure; D000077300:Bosentan; D002830:Choroid Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D013449:Sulfonamides; D000077300:Bosentan
keywords: Bosentan; Choroidal melanoma; Endothelin; Pulmonary hypertension