The Canadian journal of cardiology
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Comparative Study
Hemodynamic stability after transitioning between endothelin receptor antagonists in patients with pulmonary arterial hypertension.
Maintenance of a favourable hemodynamic profile is central to therapeutic success in pulmonary arterial hypertension (PAH). There is little information about the safety of transitioning patients between oral therapies for PAH. Endothelin receptor antagonists (ERAs) have been a therapeutic mainstay in PAH, providing benefit to many patients. Three ERAs, bosentan, sitaxsentan, and ambrisentan have been approved for clinical use. Sitaxsentan was voluntarily withdrawn from the market in late 2010 resulting in the need to quickly transition a large number of stable patients. ⋯ Transitioning between ERAs in stable PAH patients does not result in hemodynamic or clinical deterioration during the first 4 months posttransition. A minority of patients have developed increased cardiac filling pressures.
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Case Reports
Infective endocarditis presenting as an isolated aneurysm of the posterior mitral leaflet.
We describe the case of a 64-year-old woman in whom an aneurysm located on the posterior mitral leaflet was detected. Blood cultures grew methicillin-sensitive Staphylococcus epidermidis, and histologic examination of the operative specimen showed polymorphonuclear neutrophilic infiltration of the valve wall associated with fibrin and necrosis, consistent with a diagnosis of endocarditis. The posterior mitral location of the aneurysm and the absence of vegetation are exceptionally rare in this setting. This case demonstrates that a mitral aneurysm may be the sole cardiac presentation of infective endocarditis.