[HSF] Bosentan

Wed Nov 8 10:54:33 EST 2006

Tomas 
very well said 

NFA

> From: Salerno, Tomas
> This interaction of surgeons in this forum has been very constructive.
> We do not have to agree, but we get some new ideas. I certainly have
> learned a lot from these discussions, have changed my practice, made
> friends, and have a better understanding that we are all together,
> facing difficult problems, and it is nice to share them with a group of
> great surgeons.
> 
> Tomas
> 
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of
> prasannasimha
> Sent: Wednesday, November 08, 2006 10:10 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Bosentan
> 
> 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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