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Long-term safety, tolerability and efficacy of bosentan in adults with pulmonary arterial hypertension associated with congenital heart disease
  1. Gerhard-Paul Diller1,
  2. Konstantinos Dimopoulos1,
  3. Mehmet G Kaya1,
  4. Carl Harries1,
  5. Anselm Uebing2,
  6. Wei Li1,
  7. Evdokia Koltsida1,
  8. J Simon R Gibbs3,
  9. Michael A Gatzoulis1
  1. 1Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, and the National Heart and Lung Institute, Imperial College of Science and Medicine, London, UK
  2. 2Department of Paediatric Cardiology and Biomedical Engineering, University Hospital of Schleswig-Holstein, Kiel, Germany
  3. 3Department of Cardiology, Hammersmith Hospital, London, UK
  1. Correspondence to:
    Professor M A Gatzoulis
    Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; m.gatzoulis{at}rbh.nthames.nhs.uk

Abstract

Objective: To examine long-term safety and efficacy of bosentan—an oral dual endothelin receptor antagonist—in patients with pulmonary hypertension associated with congenital heart disease or Eisenmenger’s syndrome.

Design: Retrospective study.

Setting: Tertiary cardiology referral centre.

Patients: All adult patients with pulmonary arterial hypertension associated with congenital heart disease treated with bosentan at the Royal Brompton Adult Congenital Heart Centre were included.

Main outcome measures: Oxygen saturation, functional (WHO) class, 6-minute walk test distance and liver enzymes were analysed.

Results: Eighteen patients (14 female) with pulmonary arterial hypertension associated with congenital heart disease (15 patients with Eisenmenger’s syndrome) with a mean (SD) age of 41 (9) years (range 23–69) were included. Median follow-up was 29 months (range 1–39). One patient died during follow-up. Patients tolerated bosentan well and no significant rise in liver transaminases was seen. Arterial oxygen saturation remained stable throughout follow-up. Mean (SD) functional class (p = 0.001) and the 6-minute walk test distance improved compared with baseline (284 (144) vs 363 (124) m, 380 (91) m and 408 (114) m at baseline, 0–6 months, 6–12 months and 1–2 years of treatment, respectively; p<0.05 for each).

Conclusions: Bosentan appears to be safe and well tolerated in adults with pulmonary arterial hypertension associated with congenital heart disease or Eisenmenger’s syndrome during mid- to long-term follow-up. In addition, functional class and the 6-minute walk test distance improved and this effect was maintained for up to 2 years of bosentan treatment.

  • PAH, pulmonary arterial hypertension
  • SMWTd, 6-minute walk test distance
  • VSD, ventricular septal defect
  • bosentan
  • congenital heart disease
  • Eisenmenger’s syndrome
  • endothelin antagonism
  • pulmonary arterial hypertension

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Footnotes

  • Conflicts of interests: None declared.

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