scholarly journals Adult patients with pulmonary arterial hypertension due to congenital heart disease: a review on advanced medical treatment with bosentan

2010 ◽  
pp. 359
Author(s):  
Jeroen Vis ◽  
Mark J Schuuring ◽  
Jeroen Vis ◽  
Marielle G Duffels ◽  
Berto J Bouma ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Medical Treatment ◽  
Congenital Heart ◽  
Adult Patients ◽  
Pulmonary Arterial

scholarly journals Subcutaneous treprostinil in congenital heart disease-related pulmonary arterial hypertension

Heart ◽  
2018 ◽  
Vol 104 (14) ◽  
pp. 1195-1199 ◽  
Author(s):  
Nika Skoro-Sajer ◽  
Christian Gerges ◽  
Olga Hajnalka Balint ◽  
Dora Kohalmi ◽  
Monika Kaldararova ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Mixed Model ◽  
Adult Patients ◽  
Class Iii ◽  
Infusion Site ◽  
Pulmonary Arterial

ObjectiveTo assess the efficacy and safety of subcutaneous treprostinil in adult patients with congenital heart disease (CHD)-associated pulmonary arterial hypertension (PAH) after 12 months of treatment.MethodsConsecutive adult patients with CHD–PAH received subcutaneous treprostinil to maximum tolerated doses in an observational study.ResultsAdvanced CHD–PAH patients with WHO class III or IV disease (n=32, age 40±10 years, 20 females) received treprostinil for suboptimal response to bosentan (n=12), WHO functional class IV disease (FC, n=7) or prior to bosentan approval (n=13). In the multivariate mixed model, mean increase in 6 min walk distance (6-MWD) from baseline to 12 months was 114 m (76; 152) (P<0.001). WHO FC improved significantly (P=0.001) and B-type brain natriuretic peptide decreased from 1259 (375; 2368) pg/mL to 380 (144; 1468) pg/mL (P=0.02). In those 14 patients who had haemodynamic data before and after initiation of treprostinil, pulmonary vascular resistance decreased significantly (from 18.4±11.1 to 12.6±7.9 Wood units, P=0.003). The most common adverse events were infusion-site erythema and pain. One patient stopped treatment because of intolerable infusion-site pain after 8 months of treatment. No other major treatment-related complications were observed. Five patients died during early follow-up, having experienced a decrease in their 6-MWD prior.ConclusionsSubcutaneous treprostinil therapy is generally safe and effective for at least 12 months and may be used in CHD-related PAH class III and IV.

scholarly journals Efficacy of Bosentan in a Small Cohort of Adult Patients With Pulmonary Arterial Hypertension Related to Congenital Heart Disease

CHEST Journal ◽  
2006 ◽  
Vol 129 (4) ◽  
pp. 1009-1015 ◽  
Author(s):  
Raymond L. Benza ◽  
Barry K. Rayburn ◽  
Jose A. Tallaj ◽  
Christopher S. Coffey ◽  
Laura J. Pinderski ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Adult Patients ◽  
Small Cohort ◽  
Pulmonary Arterial

Arrhythmias in adult patients with congenital heart disease and pulmonary arterial hypertension

Heart ◽  
2018 ◽  
Vol 104 (23) ◽  
pp. 1963-1969 ◽  
Author(s):  
Maria Drakopoulou ◽  
Heba Nashat ◽  
Aleksander Kempny ◽  
Rafael Alonso-Gonzalez ◽  
Lorna Swan ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Adult Patients ◽  
Long Term Outcome ◽  
Clinical Variables ◽  
Pulmonary Arterial

ObjectivesApproximately 5%–10% of adults with congenital heart disease (CHD) develop pulmonary arterial hypertension (PAH), which affects life expectancy and quality of life. Arrhythmias are common among these patients, but their incidence and impact on outcome remains uncertain.MethodsAll adult patients with PAH associated with CHD (PAH-CHD) seen in a tertiary centre between 2007 and 2015 were followed for new-onset atrial or ventricular arrhythmia. Clinical variables associated with arrhythmia and their relation to mortality were assessed using Cox analysis.ResultsA total of 310 patients (mean age 34.9±12.3 years, 36.8% male) were enrolled. The majority had Eisenmenger syndrome (58.4%), 15.2% had a prior defect repair and a third had Down syndrome. At baseline, 14.2% had a prior history of arrhythmia, mostly supraventricular arrhythmia (86.4%). During a median follow-up of 6.1 years, 64 patients developed at least one new arrhythmic episode (incidence 3.47% per year), mostly supraventricular tachycardia or atrial fibrillation (78.1% of patients). Arrhythmia was associated with symptoms in 75.0% of cases. The type of PAH-CHD, markers of disease severity and prior arrhythmia were associated with arrhythmia during follow-up. Arrhythmia was a strong predictor of death, even after adjusting for demographic and clinical variables (HR 3.41, 95% CI 2.10 to 5.53, p<0.0001).ConclusionsArrhythmia is common in PAH-CHD and is associated with an adverse long-term outcome, even when managed in a specialist centre.

scholarly journals Use of Pulmonary Arterial Hypertension Therapies in Patients with a Fontan Circulation: Current Practice Across the United Kingdom

2021 ◽  
Author(s):  
Andrew Constantine ◽  
Konstantinos Dimopoulos ◽  
Petra Jenkins ◽  
Robert M. R. Tulloh ◽  
Robin Condliffe ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Fontan Circulation ◽  
Adult Patients ◽  
The United Kingdom ◽  
Pulmonary Arterial

Background The Fontan circulation is a successful operative strategy for abolishing cyanosis and chronic volume overload in patients with congenital heart disease with single ventricle physiology. “Fontan failure” is a major cause of poor quality of life and mortality in these patients. We assessed the number and clinical characteristics of adult patients with Fontan physiology receiving pulmonary arterial hypertension (PAH) therapies across specialist centers in the United Kingdom. Methods and Results We identified all adult patients with a Fontan‐type circulation under active follow‐up in 10 specialist congenital heart disease centers in England and Scotland between 2009 and 2019. Patients taking PAH therapies were matched to untreated patients. A survey of experts was also performed. Of 1538 patients with Fontan followed in specialist centers, only 76 (4.9%) received PAH therapies during follow‐up. The vast majority (90.8%) were treated with a phosphodiesterase‐5 inhibitor. In 33% of patients, PAH therapies were started after surgery or during hospital admission. In the matched cohort, treated patients were more likely to be significantly limited, have ascites, have a history of protein‐losing enteropathy, or receive loop diuretics ( P <0.0001 for all), also reflecting survey responses indicating that failing Fontan is an important treatment target. After a median of 12 months (11–15 months), functional class was more likely to improve in the treated group ( P =0.01), with no other changes in clinical parameters or safety issues. Conclusions PAH therapies are used in adult patients with Fontan circulation followed in specialist centers, targeting individuals with advanced disease or complications. Follow‐up suggests stabilization of the clinical status after 12 months of therapy.

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