A63-22 Peri-Operative Transition of Oral to Intravenous Treprostinil: A Case Report
Abstract
Pulmonary arterial hypertension (PAH) is associated with high peri-operative morbidity and mortality, and peri-operative management of PAH-specific therapies is critical to minimize complications.
A 29-year-old female with idiopathic PAH presented with abdominal pain. Right heart catheterization one year prior revealed RA 10 mmHg, PA 94/41 (63) mmHg, PCWP 9 mmHg, Fick Cardiac Output 4.11 L/min, Fick Cardiac Index 2.43 L/min/m2, PA saturation 63% and PVR 11.4 Woods Units. Transthoracic echocardiogram six months prior showed a mildly dilated right ventricle with preserved systolic function and no pericardial effusion. She remained WHO functional class I and low risk per REVEAL 2.0 and ESC/ERS stratification. She had been maintained on macitentan, tadalafil, and oral treprostinil 10mg TID, and subcutaneous sotatercept was added following this testing. On admission, abdominal computed tomography confirmed a recurrent tubo-ovarian abscess complicated by left hydronephrosis. She had failed prior antibiotic treatment, therefore surgical intervention was recommended. Tadalafil and macitentan were continued perioperatively. Given her NPO status for surgery, oral treprostinil was planned to transition to equivalent dose intravenous treprostinil 40ng/kg/min with dosing weight 95 kg without invasive hemodynamic monitoring (table 1). The day prior to the surgery, intravenous treprostinil was initiated at 20 ng/kg/min with the mid-day dose of oral treprostinil and infusion rate was…
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