[HSF] Bosentan

Wed Nov 8 10:55:52 EST 2006

Dear Prasanna ....
take a breath ... 

NFA

> From: prasannasimha
> That is true.
> We have had such long drawn out conversations with Dr Salerno and he
> answers so elegantly. We may not be able to reproduce his technique
> easily but from these conversations we learn (at least I do) a lot. I
> learn something from the HSF nearly every day and I feel in some ways
> that contributing back is one way to keep the spirit of the forum going.
> Making pointed attacks after asking a question is plain simple puerile
> and immature ( iteration but sounds nice !!). If the cardiologist is
> ignorant about the use of  drug , shame on him - but if the surgeon
> cannot understand inappropriate use of a drug and needs it to be spelt
> out to him and fails to understand it even after it is told to him -
> then what can be said about that !! Desperate lashing out at people who
> try to help is pathetic.Classical sign of bully .
> Prasanna
> hgrmd at aol.com wrote:
> > Prasanna,
> >   I couldn't agree more.  People who take offense to the answers given
for their
> questions should simply not clutter HSF with their input.  I don't agree
with a lot said
> on HSF and I'm sure vice versa is true.  However, I find this forum
extremely valuable
> to my practice.
> > Hal
> >
> >
> > -----Original Message-----
> > From: prasannasimha at gmail.com
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Wed, 8 Nov 2006 9:01 AM
> > Subject: Re: [HSF] Bosentan
> >
> >
> > What - Machismo ?.
> > The Bosentan has been started for PH obviously. I cannot understand why
you have
> to take umbrage at it. We see a lot of (sometimes unnecessary) drugs
started prior to
> surgery and they need not be restarted if not required (the "for the life
of me" was
> referred to the starting of that drug - for pulmonary hypertension for
mechanical
> pulmonary hypertension). Any pharmacology book could be referred for the
use of
> this drug. You could have done that anyway.What I said were real incidents
and not
> "Machismo". There is a simple thing called as delete button which you are
welcome to
> use if you are irritated !! Or simply don't ask if you don't want any
opinions !!
> > You asked a question and I answered honestly. I presume you wanted
opinions
> when you came to the forum with your problem. If you are given examples
from the
> real world and then call it machismo and irritating you seem to then have
a problem.
> If you cannot accept it - I cannot be apologetic about it !!
> > The examples were given to show that pulmonary vasodilators (including
bosentan)
> have a minimal role practically after correction of mitral valve disease.
Instead of
> getting irritated about "imaginary slights" you should have bothered to
understand the
> meaning of the message. I refuse to be drawn further into a flaming match.
> > The simple answer to the Bosentan question is that it can be stopped
preop without
> much ado about nothing.
> > Prasanna
> >
> > geconomo wrote:
> >
> >> Dear Members,
> >> Thank you very much for your response ,but the issue was not how to >
deal with
> PH secondary to MV pathology but how to handle this > particular drug on a
preop pat
> who for reasons that are not explained > to me at present ,is taking it
for the last 6
> months!. His last cath > verified the presence of PH( 70-90mmHg,with SAP
of 90-
> 100mmHg). It > seems that B Bistrup has the clues (I guess a seasoned CV
surgeon)
> > that a pulmonary or local cardiology guru had used the "miracle drug" >
on this
> case.
> >> Anyway,thank you again, but please (I am reffering to psimha) not so >
much
> surgical machismo . Believe me, sometimes it becomes very > irritating to
say the
> least!
> >> George Economopoulos,MD,FACS.
> >>
> >>
> >> ----- Original Message ----- From: "prasannasimha" >
> <prasannasimha at gmail.com>
> >> To: <OpenHeart-L at lists.hsforum.com>
> >> Sent: Monday, November 06, 2006 9:12 PM
> >> Subject: Re: [HSF] Bosentan
> >>
> >>
> >>
> >>> For the life of me - the pulmonary hypertension of mitral stenosis is
>> usually
> reversible and very rarely persists. I do not really think >> Bosentan is
helping and
> any way simple nitrates or temporary >> Sildenafil can very well help.
> >>> Last week I did a mitral repair in a patient with systemic PA >>
pressures and
> LA clot and that patient had persistent high PA >> pressures which
responded well to
> temporary Sildenafil. It has been >> stopped now with PA pressures
decreasing.
> >>> Basically patient with mitral stenosis with irreversible pulmonary >>
> hypertension are those with secondary hemosiderosis or another cause >> of
lung
> damage.
> >>> 2 weeks back I did an emergent MVR = TV plasty + emaze for a case of
>> MV
> rupture during a balloon mitral valvotomy. Patient had difficulty >>
weaning of CPB
> and needed Milrinone SNP, NTG and some period of >> Nitric oxide (1 hour)
using a
> Lazarus technique to maintain systemic >> pressures in the presence of
high doses of
> vasodilators. It turned >> out that this patient had severe emphysema and
a urethral
> stricture >> to boot. The balloonists had not bothered to evaluate his
lungs !!
> >>> Any way he was weaned of NO etc and then placed on Sildenafil and >>
his PA
> pressures came down to "acceptable" levels by post op day 4 >> (though he
still had
> a high trans pulmonary gradient). My point is >> it is rare to have
persistent
> pulmonary hypertension after mitral >> valve surgery. If it persists I
would first check
> for inadequate >> correction or a secondary cause before blaming it to
mitral stenosis
> >> per se. (And I have had my fair share of RHD)
> >>> Prasanna
> >>>
> >>> geconomo wrote:
> >>>
> >>>> Dear Members,
> >>>>
> >>>> I will appreciate any input about the preoperative use of Bosentan
>>> on a
> patient who is about to undergo an MVR (mitral stenosis) and >>> has
moderate to
> severe Pulmonary Hypertension treated with Bosartan >>> among other meds .
> >>>> Should our original plan for MVR with a mechanical valve change if
>>> he will
> take the drug postop?(hepatoxicity) If the drug is >>> discontinued postop
is there
> any chance of PH rebound? (despite the >>> MVcorrected problem).
> >>>> If any of you has any experience with this drug I will appreciate >>>
his/her
> input.
> >>>>
> >>>> George Economopoulos MD
> >>>> Athens Greece
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