Key result
Upfront triple therapy increases cardiac index ~76%, enabling safe surgery in a severe PAH case.
Case Report (n=1)
No
Careful intensive management with upfront triple combination therapy can reduce perioperative risks in patients with severe PAH undergoing non-cardiac surgery.
Answers are grounded in this paper and cite their sources.
Single-case report of perioperative success with triple PAH therapy; hypothesis-generating and should not yet change practice.
A 47-year-old woman with idiopathic pulmonary arterial hypertension (IPAH) was referred to our hospital for treatment of an ovarian tumor. Although chest contrast-enhanced CT scans obtained on admission revealed pulmonary arterial thrombosis, she was diagnosed with IPAH with central pulmonary thrombosis based on a normal perfusion lung scan. We initiated upfront triple combination therapy with pulmonary vasodilators. After one month of the therapy, the patient's pulmonary hemodynamics improved. Gynecological surgery was performed under general anesthesia without any perioperative complications. Providing careful intensive management of patients with severe PAH can reduce the perioperative risks of non-cardiac and non-obstetric surgery.
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Umezawa et al. (2014) conducted a case report in Idiopathic pulmonary arterial hypertension with central pulmonary thrombosis (n=1). Upfront triple combination therapy (bosentan, tadalafil, epoprostenol) was evaluated on Pulmonary hemodynamics (Cardiac Index and Pulmonary Vascular Resistance). Upfront triple combination therapy improved the cardiac index from 1.58 to 2.78 L/min/m2 and allowed for safe gynecological surgery without perioperative complications in a patient with severe idiopathic pulmonary arterial hypertension.
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