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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 11  |  Issue : 2  |  Page : 139-140
Bosentan for the treatment of portopulmonary hypertension


Department of Anaesthesiology and Intensive Care, GB Pant Hospital, New Delhi 110 002, India

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How to cite this article:
Tempe DK, Datt V, Datta D. Bosentan for the treatment of portopulmonary hypertension. Ann Card Anaesth 2008;11:139-40

How to cite this URL:
Tempe DK, Datt V, Datta D. Bosentan for the treatment of portopulmonary hypertension. Ann Card Anaesth [serial online] 2008 [cited 2019 Jul 15];11:139-40. Available from: http://www.annals.in/text.asp?2008/11/2/139/41595


The Editor,

We read with great interest the recently published article by Raja and colleagues. [1] The authors have described bosentan as a therapeutic option for the treatment of pulmonary arterial hypertension of varied origin, including primary pulmonary arterial hypertension in adults and the ones associated with congenital heart or connective tissue diseases in children.

We would like to add that bosentan therapy in usual or low doses, alone or in combination with other pulmonary vasodilators, has been used successfully in patients with portopulmonary hypertension (PPHTN). PPHTN is common in patients with advanced liver disease of different causes and is possibly due to excess endothelin-1 in the pulmonary circulation. [2],[3] Since PPHTN has been reported in patients with nonhepatic portal hypertension, the common factor that determines its development is portal hypertension. [4]

The first clinical experiences with bosentan in patients with Child A cirrhosis and severe PPHTN were reported by Hoeper and colleagues in 2005. [5] A total of 11 consecutive patients with cirrhosis and severe PPHTN were treated for >1 year with bosentan. All patients showed improved symptoms and exercise capacity with significant decrease in pulmonary vascular resistance. Subsequently, it was shown that bosentan is a better therapeutic option as compared with inhaled iloprost, and it is safe with regard to liver function. [6] Recently, it has also been shown to be an effective agent as a part of combination therapy of PPHTN (prostacyclin, sildenafil, and bosentan) in a patient awaiting liver transplantation. [7] Thus, patients who would be excluded from a liver transplantation programme because of PPHTN can benefit with this therapy. The present data suggest that the dual endothelin receptor antagonist bosentan may offer a safe and effective noninvasive alternative in patients with PPHTN.

 
   References Top

1.Raja SG, Dreyfus GD. Current status of bosentan for treatment of pulmonary hypertension. Ann Card Anaesth 2008;11:6-14.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Benjaminov FS, Prentice M, Sniderman KW, Siu S, Liu P, Wong F. Portopulmonary hypertension in decompensated cirrhosis with refractory ascites. Gut 2003;52:1355-62.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Hoeper MM, Krowka MJ, Strassburg CP. Portopulmonary hypertension and hepatopulmonary syndrome. Lancet 2004;363:1461-8.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Herve P, Lebrec D, Brenot F, Simonneau G, Humbert M, Sitbon O, et al . Pulmonary vascular disorders in portal hypertension. Eur Respir J 1998;11:1153-66.  Back to cited text no. 4    
5.Hoeper MM, Halank M, Marx C, Hoeffken G, Seyfarth HJ, Schauer J, et al . Bosentan therapy for portopulmonary hypertension. Eur Respir J 2005;25:502-8  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Hoeper MM, Seyfarth HJ, Hoeffken G, Wirtz H, Spiekerkoetter E, Pletz MW, et al . Experience with inhaled iloprost and bosentan in portopulmonary hypertension. Eur Respir J 2007;30:1096-102.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Austin MJ, McDougall NI, Wendon JA, Sizer E, Knisely AS, Rela M, et al . Safety and efficacy of combined use of sildenafil, bosentan and iloprost before and after liver transplantation in severe portopulmonary hypertension. Liver Transpl 2008;14:287-91.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Deepak K Tempe
Department of Anaesthesiology and Intensive Care, GB Pant Hospital, New Delhi 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.41595

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