Conversione dall'epoprostenolo ev al treprostinil sc in un giovane paziente affetto da severa ipertensione arteriosa polmonare

The case of a 22 year-old patient with severe pulmonary arterial hypertension (NYHA class III) is described; the patient underwent surgical correction of congenital ventricular septal defect in infancy. The patient was treated with high dose continuous iv epoprostenol and endothelin receptor antagonists with improvement of clinical status, exercise capacity and pulmonary hemodynamics. The patient had then developed pulmonary bilateral septic embolis in sepsis by Staphilococcus hominis and endocarditis of valve tricuspide. After adequate and long antibiotic therapy, several positive haemocoltures were observed. Consequently the port-a-cath was removed and transition from iv epoprostenol to subcutaneous treprostinil was provided for. It's the first case of transition from iv to subcutaneous prostacicline in Italy. The transition was conducted under medical supervision in hospital and was successful without major adverse side effects. The patient had undergone to screening for lung transplantation.