[HSF] Bosentan (OT)

Wed Nov 8 11:55:29 EST 2006

that is true Prasanna .... 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of psimha
> Sent: Wednesday, November 08, 2006 11:09 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Bosentan (OT)
> 
> Don't worry Nasser I any way am watching TV (in my PC) so can relax
> while typing !!
> I don't think we have become cardiac surgeons by being the type that
> will get run over easily.
> 
> Prasanna
> Nasser F. Abou'Seada wrote:
> > 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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