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Case report
Improvement after bariatric surgery in chronic thromboembolic pulmonary hypertension: a novel treatment target
  1. Anika Vaidy1,
  2. Paul Forfia2,
  3. Jeremy Mazurek3 and
  4. Anjali Vaidya2
  1. 1 Internal Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2 Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
  3. 3 Division of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Anjali Vaidya, anjali.vaidya{at}tuhs.temple.edu

Abstract

A 66-year-old man with a medical history significant for multiple pulmonary embolism and morbid obesity was evaluated for chronic thromboembolic pulmonary hypertension. Echocardiogram and right heart catheterisation were significant for severe pulmonary hypertension. Therefore, he was started on pulmonary hypertension medical therapy with riociguat and ambrisentan, in addition to anticoagulation. He experienced a dramatic clinical response to medical therapy. Despite haemodynamic improvement, the patient remained symptomatic with significant fatigue, exertional dyspnea and poor functional status as highlighted by a 6 min walk distance of only 128 m. Patient was referred for bariatric surgery with a gastric sleeve, after which he successfully lost 95 lbs in 6 months. Postoperative right heart catheterisation demonstrated normal pulmonary  vascular resistance and cardiac output. His echocardiogram revealed normal right ventricular size and function. His 6 min walk distance also nearly quadrupled from 128 to 512 m, consistent with WHO Functional Class I.

  • venous thromboembolism
  • obesity (nutrition)
  • pulmonary hypertension

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Footnotes

  • Contributors AV drafted the article and was involved in critical revisions of the article. PF was involved in the conception and design of the article. JM provided data collection. AV provided conception of the article as well as critical revisions of the article. All authors had final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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