title: Underrated value of repeated right heart catheterization in pulmonary hypertension with heart failure-a case of persisted pulmonary arterial hypertension after treatment for biventricular failure.
abstract: Pulmonary hypertension (PH) is a common complication of left heart disease and its presence in patients with heart failure predicts worse clinical outcomes. Specific agents targeting pulmonary arterial hypertension (PAH) have been developed over the last few years, but the efficacy of these agents in pulmonary hypertension due to left heart disease (PH-LHD) is uncertain. We report a case of idiopathic pulmonary arterial hypertension (IPAH) initially presented with biventricular failure, which was misdiagnosed as PH-LHD. A 31-year-old man who had a history of recurrent hemoptysis was referred to our center with biventricular failure. Right heart catheterization (RHC) showed elevated mean pulmonary arterial pressure (mPAP) and pulmonary capillary wedge pressure (PCWP). He was diagnosed as having PH-LHD, specifically combined post-capillary and precapillary PH (CpcPH). We treated him for 2 years with diuretics, a beta blocker, an angiotensin-converting enzyme (ACE) inhibitor, and sildenafil, which was added to treat CpcPH. A follow-up echocardiography showed that biventricular function had improved, but not PH. A second RHC revealed elevated mPAP and normal PCWP, which made us change the diagnosis to IPAH. In conclusion, it is important to perform repeated RHC in CpcPH patients after the improvement of left heart dysfunction to distinguish CpcPH from IPAH.
authors.affiliation: 1 Department of Internal Medicine, 2 Department of Cardiology, 3 Center for Pulmonary Hypertension and Venous Thromboembolism, 4 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Shinhee
authors.initials: S
authors.lastname: Park
authors.affiliation: 1 Department of Internal Medicine, 2 Department of Cardiology, 3 Center for Pulmonary Hypertension and Venous Thromboembolism, 4 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Yoon
authors.affiliation: 1 Department of Internal Medicine, 2 Department of Cardiology, 3 Center for Pulmonary Hypertension and Venous Thromboembolism, 4 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Soomin
authors.initials: S
authors.lastname: Jeung
authors.affiliation: 1 Department of Internal Medicine, 2 Department of Cardiology, 3 Center for Pulmonary Hypertension and Venous Thromboembolism, 4 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Nah Kyum
authors.initials: NK
authors.lastname: Lee
authors.affiliation: 1 Department of Internal Medicine, 2 Department of Cardiology, 3 Center for Pulmonary Hypertension and Venous Thromboembolism, 4 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Min-Seok
authors.initials: MS
authors.lastname: Kim
authors.affiliation: 1 Department of Internal Medicine, 2 Department of Cardiology, 3 Center for Pulmonary Hypertension and Venous Thromboembolism, 4 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: 1 Department of Internal Medicine, 2 Department of Cardiology, 3 Center for Pulmonary Hypertension and Venous Thromboembolism, 4 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.affiliation: 1 Department of Internal Medicine, 2 Department of Cardiology, 3 Center for Pulmonary Hypertension and Venous Thromboembolism, 4 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Lee
keywords: Cardiac catheterization; heart failure; idiopathic pulmonary arterial hypertension (IPAH); pulmonary hypertension (PH)