-Case Reports-

Early Effects of Oral Pulmonary Vasodilators in an Elderly Patient with Critical Thromboembolic Pulmonary Hypertension: A Case Report

Hirotake Okazaki¹, Noritake Hata¹, Akihiro Shirakabe¹, Masafumi Tsurumi¹, Takuro Shinada¹ and Wataru Shimizu²

¹Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
²Department of Cardiovascular Medicine, Nippon Medical School

A 70-year-old woman who had been treated for bipolar disorder and dementia was admitted to the intensive care unit of a university hospital with severe dyspnea; pulmonary arterial hypertension was diagnosed after cardiac catheterization was performed. Computed tomography pulmonary angiography showed typical signs of chronic thrombosis in the proximal pulmonary artery without an adequate amount of fresh thrombi, which appeared to be the cause of the elevation in pulmonary artery pressure, and resulted in severe hypoxemia. Therefore, the pulmonary arterial hypertension was classified as belonging to the chronic thromboembolic pulmonary hypertension subgroup. Although the patient's respiratory condition was classified as World Health Organization class IV, she was treated with the combination of oral ambrisentan and tadalafil, rather than intravenous epoprostenol, which she was unable to tolerate. Consequently, both her symptom and hemodynamic status showed rapid improvement with only oral pulmonary vasodilators. This case demonstrates the efficacy of oral treatment alone in elderly patients with severe chronic thromboembolic pulmonary hypertension.

J Nippon Med Sch 2015; 82: 206-210

Keywords
pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, specific pulmonary vasodilators, ambrisentan, tadalafil

Correspondence to
Hirotake Okazaki, MD, Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan
s9019@nms.ac.jp

Received, September 10, 2014
Accepted, January 8, 2015