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Vol. 13. Issue 2.
Pages 239-254 (March - April 2007)
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Vol. 13. Issue 2.
Pages 239-254 (March - April 2007)
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Pulmonary arterial hypertension – Experience of Centro Hospitalar de Vila Nova de Gaia
Hipertensão arterial pulmonar – Experiência do Centro Hospitalar de Vila Nova de Gaia
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Ana Oliveira1, Daniela Ferreira1, António Caiado2, Susana Ferreira1, Paula Ferreira1, Lino Santos3, Manuel Gonçalves4, Teresa Shiang5, Bárbara Parente6, Rosas Vieira7, Vasco Gama Ribeiro8
1 Interna Complementar de Pneumologia / Pulmonolgy resident
2 Assistente Hospitalar de Pneumologia / Pulmonolgy consultant
3 Assistente Hospitalar de Cardiologia / Cardiology consultant
4 Assistente Hospitalar Graduado de Medicina Interna / Internal Medicine specialist consultant
5 Assistente Hospitalar Graduada de Pneumologia / Pulmonolgy specialist consultant
6 Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia Rua Conceição Fernandes 4430 Vila Nova de Gaia
7 Serviço de Medicina Interna, Centro Hospitalar de Vila Nova de Gaia Rua Conceição Fernandes 4430 Vila Nova de Gaia
8 Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia Rua Conceição Fernandes 4430 Vila Nova de Gaia
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Abstract
Introduction

Pulmonary arterial hypertension (PAH) is a serious and progressive disease, potentially fatal in a few years. Until the 1990s the only effective treatment for this disease was pulmonary/cardiopulmonary transplant. Over the last few years several drugs have emerged that have modified the course of the disease.

Aims

To characterise patients with PAH followed at Centro Hospitalar de V.N.Gaia between 2000 and 2006. To raise awareness of this entity.

Material and methods

Retrospective analysis of all patients with PAH or chronic thromboembolic pulmonary hypertension (CTEPH) followed at our Hospital.

Results

In this period 11 patients were observed, 7 women and 4 men, with a mean age of 43 y. Five patients had idiopathic PAH, three had CTEPH, two had PAH associated with interauricular communication and one had PAH associated with CREST Syndrome.

At the time of diagnosis most patients were in NYHA//WHO Functional Class III/IV, mean systolic pulmonary artery pressure was 98±32mmHg and mean distance walked in the 6-minute walk test was 401m. Initial treatment: Three patients had inhaled iloprost, two subcutaneous treprostinil, three oral bosentan, one oral sildenafil and two patients underwent surgery. Mean follow-up time was 28.1 months. Five patients recovered, three are stable, one worsened and two died.

Conclusions

PAH is a serious illness which requires a multidisciplinary approach with the need for complex and expensive therapies. Diagnosis in initial stages is essential for an effective treatment.

Resumo
Introdução

A hipertensão arterial pulmonar (HAP) é uma doença grave e progressiva potencialmente fatal em poucos anos. Até à década de 90, o único tratamento eficaz para esta entidade era o transplante pulmonar/cardiopulmonar. Nos últimos anos assistiu-se ao aparecimento de novos fármacos que vieram alterar o curso da doença.

Objectivos

Caracterização dos doentes com HAP observados no Centro Hospitalar de VN Gaia no período de 2000 a 2006. Alertar para esta entidade.

Material e métodos

Análise retrospectiva de todos os doentes com HAP ou doença tromboembólica crónica em tratamento no CHVN Gaia.

Resultados

No referido período foram observados 11 doentes, 7 mulheres e 4 homens, com média etária de 43 anos. Cinco doentes com HAP idiopática, três com doença tromboembólica crónica, dois com HAP associada a comunicação interauricular e um com HAP associada a S. CREST. Ao diagnóstico, a maioria encontrava- se em classe funcional NYHA/OMS III/IV, a pressão sistólica média da artéria pulmonar foi de 98±32mmHg e a distância média percorrida na 6-MWT foi de 401m. Terapêutica inicial: Três doentes iloprost por via inalatória; dois treprostinil subcutâneo; três bosentan per os; um sildenafil per os e dois doentes foram submetidos a cirurgia. O tempo médio de follow-up é de 28,1±20.3 meses. Cinco doentes melhoraram, três mantiveram-se estáveis, um agravou e dois faleceram.

Conclusão

A HAP é uma doença grave que requer uma abordagem multidisciplinar com necessidade de terapêuticas complexas e dispendiosas. O diagnóstico em estádios precoces é essencial, de modo a permitir uma terapêutica atempada.

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Bibliography/Bibliografia
[1.]
N. Galié, for The Task Force On Diagnosis And Treatment Of Pulmonary Arterial Hypertension Of The European Society Of Cardiology, et al.
Guidelines On Diagnosis And Treatment Of Pulmonary Arterial Hypertension.
Eur J Cardiol, 25 (2004), pp. 2243-2278
[2.]
G. Simonneau, et al.
Clinical Classification of Pulmonary Arterial Hypertension.
J Am Coll Cardiol, 43 (2004), pp. S5-S12
[3.]
S. Hatano, et al.
World Health Organization 1975 Primary Pulmonary Hypertension.
WHO, (1975),
[4.]
L.J. Rubin.
Primary Pulmonary Hypertension.
N Engl J Med, 336 (1997), pp. 111-117
[5.]
S.P. Gaine, L.J. Rubin.
Primary Pulmonary Hypertension.
[6.]
S. Mehta.
Drug Therapy For Pulmonary Arterial Hypertension: What's On The Menu Today?.
Chest, 124 (2003), pp. 2045-2049
[7.]
L.J. Rubin, et al.
Diagnosis and Management of Pulmonary Artery Hypertension: ACCP Evidence-Based Clinical Practice Guidelines.
Chest, 126 (2004), pp. 1S-92S
[8.]
N. Galie, A. Manes, A. Branzi.
Prostanoids For Pulmonary Arterial Hypertension.
Am J Respir Med, 2 (2003), pp. 123-137
[9.]
R.J. Barst, L. Rubin, et al.
A Comparison Of Continuous Intravenous Epoprostenol (Prostacyclin) With Conventional Therapy For Primary Pulmonary Hypertension.
N Engl J Med, 334 (1996), pp. 296-301
[10.]
K.P. Kuhn, et al.
Outcome in 91 Consecutive Patients with Pulmonary Arterial Hypertension Receiving Epoprostenol.
Am J Respir Crit Care Med, 167 (2003), pp. 580-586
[11.]
V. McLaughlin, et al.
Survival in Primary Pulmonary Hypertension – The Impact of Epoprostenol Therapy.
Circulation, 106 (2002), pp. 1477-1482
[12.]
H. Olschewski, for The Aerosolized Iloprost Randomized (AIR) Study Group, et al.
Inhaled Iloprost For Severe Pulmonary Hypertension.
N Engl J Med, 347 (2002), pp. 322-329
[13.]
M. Hoeper, et al.
Long-Term Treatment Of Primary Pulmonary Hypertension With Aerosolized Iloprost, A Prostacyclin Analogue.
N Engl J Med, 342 (2000), pp. 1866-1870
[14.]
V.F. Tapson, et al.
Safety and Efficacy of IV Treprostinil for Pulmonary Arterial Hypertension: A Prospective, Multicenter, Open-Label, 12-Week Trial.
Chest, 129 (2006), pp. 683-688
[15.]
G. Simonneau, The Treprostinil Study Group, et al.
Continuous Subcutaneous Infusion Of Treprostinil, A Prostacyclin Analogue, In Patients With Pulmonary Arterial Hypertension: A Double-Blind, Randomized, Placebo-Controlled Trial.
Am J Respir Crit Care Med, 165 (2002), pp. 800-804
[16.]
L.J. Rubin, For the Bosentan Randomized Trial of Endothelin Antagonist Therapy (BREATHE-1) Study Group, et al.
Bosentan Therapy For Pulmonary Arterial Hypertension.
N Engl J Med, 346 (2002), pp. 896-903
[17.]
O. Sitbon, et al.
Effects of the Dual Endothelin Receptor Antagonist Bosentan in Patients With Pulmonary Arterial Hypertension – A 1-Year Follow-up Study.
Chest, 124 (2003), pp. 247-254
[18.]
V. McLaughlin, et al.
Survival With First-Line Bosentan In Patients With Primary Pulmonary Hypertension.
Eur Respir J, 25 (2005), pp. 244-329
[19.]
M. Hoeper, et al.
Bosentan Therapy for Inoperable Chronic Thromboembolic Pulmonary Hypertension.
Chest, 128 (2005), pp. 2363-2367
[20.]
E.D. Michelakis, et al.
Long-Term Treatment With Oral Sildenafil Is Safe and Improves Functional Capacity and Hemodynamics in Patients With Pulmonary Arterial Hypertension.
Circulation, 108 (2003), pp. 2066-2069
[21.]
N. Galiè, for the Sildenafil Use in Pulmonary Arterial Hypertension (SUPER) Study Group, et al.
Sildenafil Citrate Therapy for Pulmonary Arterial Hypertension.
N Engl J Med, 353 (2005), pp. 2148-2157
[22.]
H.J. Seyfarth, et al.
Bosentan Improves Exercise Tolerance and Tei Index in Patients With Pulmonary Hypertension and Prostanoid Therapy.
Chest, 128 (2005), pp. 709-713
[23.]
L. Stiebellehner, et al.
Long-term Treatment With Oral Sildenafil in Addition to Continuous IV Epoprostenol in Patients With Pulmonary Arterial Hypertension.
Chest, 123 (2003), pp. 1293-1295
[24.]
M. Humbert, et al.
Combination Of Bosentan With Epoprostenol In Pulmonary Arterial Hypertension: BREATHE- 2.
Eur Respir J, 24 (2004), pp. 353-359
[25.]
M. Gomberg-Maitland, et al.
Efficacy And Safety Of Sildenafil Added To Treprostinil In Pulmonary Hypertension.
Am J Cardiol, 96 (2005), pp. 1334-1336
Copyright © 2007. Sociedade Portuguesa de Pneumologia
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