Bosentan treatment in chronic pulmonary venous hypertension with significant right heart dysfunction

ABSTRACTBackground: Pulmonary venous hypertension (PVH) is very common. The mechanism of PVH is still under discussion and might constitute a ‘hyperactive’ form of pulmonary vascular remodelling which leads to an inappropriate increase in pulmonary vascular resistance and subsequent significant right heart dysfunction. According to current opinion, the oral dual endothelin (ETA/ETB) antagonist bosentan is not indicated for PVH. We investigated prospectively bosentan in two patients with postcapillary venous hypertension (PVH) to resolve right heart failure.Methods: One patient presented with high-grade aortic stenosis, judged inoperable due to severe congestive liver, pancreatic and bowel disease; the other had a mitral valve replacement 14 years ago. Invasive evaluation of reversibility of pulmonary hypertension with intravenous epoprostenol was performed, and subsequently a test administration of bosentan was given to exclude a significant increase in left ventricular filling pressure. Thereafter bosent...