[HSF] Bosentan(OT)

Nasser F. Abou'Seada nfaabouseada at gmail.com
Wed Nov 8 11:07:10 EST 2006 

another wrestling in the mud ???? 

NFA

> -----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 9:47 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Bosentan(OT)
> 
> If you did then pray tell me why you wanted to insult me ?
> Prasanna
> 
> geconomo wrote:
> > So do I !
> > ----- Original Message ----- From: "prasannasimha"
> > <prasannasimha at gmail.com>
> > To: <OpenHeart-L at lists.hsforum.com>
> > Sent: Wednesday, November 08, 2006 4:01 PM
> > 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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