Cardiac Changes Due to PH During Pregnancy Reversed by Combo Therapy in Case Study

Özge Özkaya, PhD avatar

by Özge Özkaya, PhD |

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PH case study

A triple combination therapy with Tracleer (bosentan), Revatio (sildenafil), and Veletri (epoprostenol) can completely reverse the right ventricular remodeling that occurs in pulmonary hypertension, according to a case study published in the journal Respiratory Medicine Case Reports.

Right ventricular remodeling refers to changes that occur in the structure and function of the lower right chamber of the heart (right ventricle), which pumps blood to the lungs. These changes occur as a result of rising pressure within the lung’s arteries, known as pulmonary hypertension.

The study, “Right ventricular reverse remodelling in Idiopathic Pulmonary Arterial Hypertension diagnosed during pregnancy: Is it possible?,” reports the case of a 36-year-old woman who developed a severe form of pulmonary arterial hypertension during a first pregnancy, due to an unknown cause. Her regular pregnancy cardiac exams were normal until the seventh month of gestation.

When she arrived at the hospital, she was 34 weeks pregnant and had severe shortness of breath on physical exertion. Medical examination revealed that her resting heart rate was faster than normal (tachycardia), that she had low blood pressure, and abnormally rapid breathing (tachypnea).

Blood tests also showed abnormally low levels of both oxygen and carbon dioxide, and an echocardiography (ECG) revealed severe dilation of the lower right chamber of her heart.

The baby was delivered in an emergency cesarean section, and the woman was treated with Dobutrex (dobutamine) for heart failure and Lasix (furosemide) against fluid buildup caused by heart failure.

But the woman’s condition did not improve. She was given Revatio, a drug often used to treat pulmonary arterial hypertension, but she responded poorly.

On the second day, following a multidisciplinary meeting, a continuous injection of Veletri, an effective blood vessel dilator that inhibits the formation of blood clots, was added to her treatment.

On the sixth day, Tracleer, another drug used to treat pulmonary arterial hypertension, was also added to her background therapy.

The woman responded well to this combination treatment, and was discharged after being hospitalized for one month.

After three months of treatments with these three drugs, her ECG parameters and the distance she could walk in six minutes returned to normal. Her prescribed dose of Veletri was progressively reduced and stopped after one year.

The doctors reported that the woman is still taking both Revatio and Tracleer two years after stopping Veletri, and that her parameters are stable “with a quite normal functional activity.” They concluded that, in a “very compromised” pregnancy, an “upfront” triple combination therapy could lead to complete reverse remodeling of the right ventricle and significantly improve survival.