epoprostenol intravenous / Generic mfg. - LARVOL DELTA

The Silent Threat: Unmasking Combined Post- and Pre-capillary Pulmonary Hypertension (CpcPH) in an Elderly Patient With Heart Failure With Preserved Ejection Fraction (HFpEF). (PubMed, Cureus) - "Because the severity of pulmonary vascular disease appeared disproportionate to isolated HFpEF-related pulmonary hypertension, the patient underwent multidisciplinary evaluation at a specialized pulmonary hypertension center, where an individualized treatment strategy with intravenous epoprostenol and sildenafil was initiated, resulting in improvement in functional status and oxygen requirements during hospitalization. Progressive right ventricular remodeling, syncope, and worsening oxygen requirements should prompt consideration of pulmonary hypertension when clinical deterioration appears disproportionate to the underlying cardiopulmonary disease. Early recognition, serial echocardiographic assessment, timely right heart catheterization, and referral to specialized pulmonary hypertension centers are essential for establishing an accurate diagnosis and guiding individualized management."

Journal • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Coronary Artery Disease • Heart Failure • Hypertension • Obstructive Sleep Apnea • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Sleep Disorder

Nebulized Nitroglycerin as a Rescue Bridge to Inhaled Nitric Oxide in Severe Pulmonary Hypertension (ASA 2026) - "A 53-year-old woman with a 15-year history of Scleroderma complicated by interstitial lung disease, pulmonary arterial hypertension, acute-on-chronic right ventricular failure, HFpEF (LVEF 55%), COPD, rheumatoid arthritis and OSA was transferred for a lung transplant evaluation on phenylephrine, vasopressin, inhaled nitric oxide (iNO), and IV epoprostenol. Without iNO immediately available, nebulized nitroglycerin and an epinephrine infusion were used as bridge pulmonary vasodilators for RV support. This successfully stabilized the patient to allow for a transition to iNO once procured."

Cardiovascular • Chronic Obstructive Pulmonary Disease • Immunology • Inflammatory Arthritis • Interstitial Lung Disease • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Rheumatoid Arthritis • Scleroderma • Systemic Sclerosis

Competing Interests: Care of the Incarcerated Complex Cardiac Patient (ASA 2026) - "Underwent MVr and TVr c/b cardiogenic shock and RV failure requiring inotropic support, iNO, and IV epoprostenol...Four months following her index operation required re-do MVR and TVr. Her entire post-op course was complicated by her complex medical presentation along with multiple ethical concerns without a proper decision-maker as a ward of the state."

Clinical • Cardiovascular • Pulmonary Disease

MAC for D&E in Pregnant Patient with Life Threatening Pulmonary Hypertension (ASA 2026) - "Surgery is performed under MAC with versed and propofol, continuation of norepinephrine, IV epoprostenol and inhaled nitric oxide, A-line monitoring, and CT surgery/ECMO on standby. This case demonstrates anesthesia challenges associated with life threatening pulmonary hypertension in the setting of pregnancy."

Clinical • Cardiovascular • Genetic Disorders • Lung Cancer • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Septic Shock

A Protocolized Intravenous Epoprostenol Pathway for Frostbite: A Canadian Burn Centre Quality Improvement and Implementation Report. (PubMed, J Burn Care Res) - "Iloprost is the prostacyclin analogue most often described, but access may be delayed in some Canadian settings. Protocol-guided intravenous epoprostenol was feasible and generally well tolerated. Findings should be interpreted as descriptive and hypothesis-generating rather than evidence of treatment efficacy."

Journal

Delayed-onset portopulmonary hypertension following liver transplantation with near hemodynamic normalization on triple therapy. (PubMed, Respir Med Case Rep) - "Combination therapy with intravenous epoprostenol, macitentan, and sildenafil resulted in marked hemodynamic and clinical improvement. He was subsequently transitioned from intravenous epoprostenol to oral selexipag and has maintained near-normal pulmonary pressures for two years. This case highlights delayed post-LT PoPH and demonstrates that even late-presenting disease may achieve substantial hemodynamic improvement with aggressive, guideline-directed PAH therapy."

Journal • Cardiovascular • Hepatology • Hypertension • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Portal Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Transplantation

Lifesaving Compassionate-Use of Sotatercept in a 12-Year-old With Idiopathic Pulmonary Arterial Hypertension. (PubMed, Pulm Circ) - "Escalation to intravenous epoprostenol failed to result in clinical or hemodynamic improvement. Sotatercept therapy resulted in rapid and marked clinical recovery, including improvement in World Health Organization functional class (WHO FC) from IV to II, substantial increase in 6-min walk distance, normalization of NT-proBNP levels, and significant echocardiographic and invasive hemodynamic improvement. This case highlights the potential role of sotatercept as a rescue therapy in pediatric IPAH refractory to conventional treatment."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure • Hypertension • Pediatrics • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Rapid Onset of Pulmonary Arterial Hypertension After Liver Transplant-A Case Report. (PubMed, Reports (MDPI)) - "The patient was initiated on sildenafil and continuous intravenous epoprostenol, resulting in clinical, echocardiographic, and hemodynamic improvement. It underscores the need for heightened clinical vigilance for pulmonary vascular disease in post-transplant patients presenting with cardiopulmonary symptoms. Further research is warranted to elucidate the underlying mechanisms, risk factors, and optimal management strategies for PAH diagnosed after liver transplantation."

Journal • Cardiovascular • Coronary Artery Disease • Hepatology • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Transplantation

PULMONARY TUMOR THROMBOTIC MICROANGIOPATHY: AN UNDERRECOGNIZED DRIVER OF PULMONARY HYPERTENSION IN MALIGNANCY (ACC 2026) - "Decision-Making: Group 1 PAH was presumed and IV epoprostenol was started and titrated to 12 ng/kg/min...Anastrozole was continued, but palbociclib held... Her course, imaging, and labs were most consistent with PTTM. Early recognition is vital, as prognosis is often fatal. More clinical and translational investigations are needed for this underdiagnosed complication of malignancy."

Breast Cancer • Cardiovascular • Lung Cancer • Oncology • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia • HP

Successful Transition From IV Epoprostenol to Oral Treprostinil in Pulmonary Arterial Hypertension: A Case Report (ATS 2026) - No abstract available

Case report • Clinical • Cardiovascular • Pulmonary Arterial Hypertension • Respiratory Diseases

A Case of IgG4-Related Disease Developing During Long-Term High-Dose Intravenous Epoprostenol Therapy in a Patient With Idiopathic Pulmonary Arterial Hypertension. (PubMed, Pulm Circ) - "Systemic corticosteroids were initiated, and the patient was transitioned from IV epoprostenol to a combination of IV and inhaled treprostinil; IgG4-RD has remained in remission to date, with normalisation of serum IgG4. This case highlights a practical, minimally invasive diagnostic approach for suspected IgG4-RD in severe PAH and demonstrates the feasibility of prostacyclin modification to sustain PAH control while reducing immunosuppression."

Journal • Cardiovascular • Hypertension • Inflammation • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

A treprostinil inhaler (Yutrepia) for pulmonary hypertension. (PubMed, Med Lett Drugs Ther) - No abstract available

Journal • Cardiovascular • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Increased Incidence of Thrombosis in Patients at Risk of Heparin-Induced Thrombocytopenia Receiving Epoprostenol for Cardiac Surgery. (PubMed, J Cardiothorac Vasc Anesth) - "The rate of thrombosis in our review was considerably higher than the published data on the use of prostacyclin analogues with heparin in patients with HIT, suggesting that this strategy may not be as effective for preventing thrombosis as previously thought. Until larger studies can be conducted, it may be in the best interest of patients with HIT for surgical teams to utilize alternative agents, such as bivalirudin, for anticoagulation in cardiac surgery."

Journal • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Marked improvement in severe pulmonary arterial hypertension following airway infection in a patient with a heterozygous BMP9 nonsense mutation: a case report. (PubMed, Eur Heart J Case Rep) - "Despite receiving combination therapy with macitentan, riociguat, and intravenous epoprostenol, she continued to have severe pulmonary hypertension with suprasystemic pressure [mean pulmonary artery pressure (PAP) = 65 mmHg] for 4 years following treatment initiation. A patient with severe, treatment-resistant pulmonary hypertension exhibiting a dramatic improvement in pulmonary pressure following an AI is exceedingly rare. The present case may provide new insights into the pathophysiology of PAH."

Journal • Cardiovascular • Hypertension • Infectious Disease • Inflammation • Pneumonia • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

SEVERE PORTOPULMONARY HYPERTENSION IN A POST-LIVER TRANSPLANT PATIENT LEADING TO ACUTE RESPIRATORY FAILURE (CHEST 2025) - "He was started on intravenous epoprostenol and gradually transitioned to sildenafil and macitentan...(2023)[1] reported successful management of POPH with combined tadalafil and macitentan... Severe POPH following LT presents significant management challenges. Early recognition and aggressive treatment are crucial to improving patient outcomes. This case highlights the importance of routine hemodynamic monitoring and pulmonary screening in liver transplant recipients to ensure timely intervention for evolving pulmonary vascular complications."

Clinical • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis • Nephrology • Portal Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Renal Disease • Respiratory Diseases • Transplantation

BRIDGE TO TRANSPLANT: A CASE OF SEVERE IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION MANAGED WITH VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION AND DOUBLE-LUNG TRANSPLANTATION (CHEST 2025) - "CASE PRESENTATION: We have a 26-year-old female with cor pulmonale secondary to IPAH, listed for lung transplantation while on maximal medical therapy, including Ambrisentan, Adempas, intravenous epoprostenol, and had just started on Soteracept. DLT remains a feasible and life-saving option for patients with severe PAH requiring mechanical support, and it continues to be preferred over HLT under specified conditions. This makes the use of rescue therapies, like ECMO, critical for survival while awaiting transplantation(8)."

Clinical • Cardiovascular • Hematological Disorders • Pulmonary Arterial Hypertension • Respiratory Diseases • Thrombocytopenia • Transplantation

ECMO AS A BRIDGE TO INITIATING THERAPY IN PULMONARY HYPERTENSION: A CASE REPORT (CHEST 2025) - "While there, the patient was started on inhaled epoprostenol and required multiple vasopressors...However, the patient was able to be supported through ECMO while intravenous epoprostenol, sildenafil, and inhaled nitric oxide were titrated with improvement in her pulmonary artery pressures... In conclusion, this case demonstrates the importance of minimizing delays in diagnosis of pulmonary hypertension and also adds to the sparse literature about the utility of ECMO as a bridge to definitive pulmonary hypertension therapy."

Case report • Clinical • Cardiovascular • Gynecology • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Urinary Incontinence • Urology

OPTIC PERINEURITIS IN A PATIENT WITH LIMITED SYSTEMIC SCLEROSIS-ASSOCIATED PULMONARY HYPERTENSION (CHEST 2025) - "She was started on intravenous epoprostenol and a phosphodiesterase type-5 inhibitor, but she developed severe headaches and visual changes... OPN with ssSSc can be difficult to diagnose in PAH patients on prostacyclins, as the symptoms overlap with the side effect of PAH treatment. The management of OPN with corticosteroids should be considered with caution as corticosteroid use is rarely associated with SRC."

Clinical • Cardiovascular • Dermatology • Endocrine Disorders • Hypertension • Immunology • Ocular Inflammation • Optic Neuritis • Pulmonary Arterial Hypertension • Pulmonary Disease • Renal Disease • Respiratory Diseases • Rheumatology • Scleroderma • Systemic Sclerosis

DEVELOPMENT OF ERASMUS SYNDROME IN THE SETTING OF CHRONIC SILICOSIS (CHEST 2025) - "Given the constellation of findings including Raynaud's phenomenon, gastritis, and silicosis, he was diagnosed with Erasmus syndrome and started on a regimen of sildenafil, nifedipine and nitroglycerin paste. Due to worsening digital ischemia, intravenous epoprostenol was initiated and he was eventually discharged with sildenafil... Patients with silicosis can develop pulmonary infections, PAH, and autoimmune diseases like Erasmus syndrome. Close monitoring of cutaneous findings concerning for systemic sclerosis can initiate an evaluation for autoimmune disorders which was key to our case. Primary occupational prevention of silica exposure can reduce the risk and incidence of this disease and its complications."

Anemia • Fibrosis • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Arthritis • Lung Cancer • Lupus • Pulmonary Arterial Hypertension • Pulmonary Disease • Rare Diseases • Respiratory Diseases • Rheumatology • Scleroderma • Solid Tumor • Systemic Sclerosis • Tuberculosis

TO TAP OR NOT TO TAP: RETHINKING PERICARDIAL DRAINAGE IN CARDIOGENIC SHOCK (CHEST 2025) - "Given his severe PAH, intravenous epoprostenol was initiated... This case underscores the importance of cautious, individualized management in severe PAH complicated by pericardial effusion. Balancing the risks and benefits of invasive interventions is crucial, as conservative strategies focusing on RV optimization may prevent additional hemodynamic compromise and improve clinical outcomes."

Cardiovascular • Congestive Heart Failure • Heart Failure • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

THE UNCLASSIFIED PHENOTYPE: SEVERE PULMONARY HYPERTENSION WITH LOW DLCO AND CAPILLARY REMODELING CHALLENGING DIAGNOSTIC BOUNDARIES: A CASE REPORT (CHEST 2025) - "He was initiated on IV steroids, DuoNeb, and budesonide nebulizations, along with IV diureses...The patient was aggressively diuresed and was initiated on inhaled Flolan therapy. Given the severity of his PH with reduced CI and severely elevated PVR, the patient was then transferred to a tertiary care center for IV Epoprostenol therapy and evaluation for a lung transplant... This case report highlights the diagnostic challenges and the importance of considering capillary remodeling in patients with rapidly progressing severe PH with low DLCO and smoking history and a need for early referral to lung transplant. Advanced imaging, genetic studies, and more detailed clinical profiles can aid in refining diagnostic criteria and potentially lead to new subcategories in PH classification that are more inclusive of these phenotypes."

Case report • Clinical • Cardiovascular • Congestive Heart Failure • Dyslipidemia • Heart Failure • Immunology • Nicotine Addiction • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Tobacco Addiction

NOT QUITE COPD? PULMONARY HYPERTENSION IN A PATIENT WITH TOBACCO USE (CHEST 2025) - "During vasoreactivty testing with intravenous epoprostenol, he showed partial hemodynamic improvement after titration to 10ng/kg/min (mPAP 49, PCWP 11, CI 2.5), however he felt subjectively worse with each dose increase... Given the high mortality associated with PVOD, early recognition of its cardinal signs on imaging and noninvasive testing is crucial . Increased awareness of environmental and occupational exposures may aid in earlier recognition and risk stratification of at-risk individuals."

Clinical • Cardiovascular • Chronic Obstructive Pulmonary Disease • Congestive Heart Failure • Fibrosis • Heart Failure • Hematological Disorders • Hepatology • Immunology • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Management of Perioperative Heparin-Induced Thrombocytopenia (HIT) with Pre-Operative Plasmapheresis and Intra-Operative IV Epoprostenol Infusion in a Patient with Thrombosed Mechanical Tricuspid Valve (TV) (ASA 2025) - "Intravenous heparin (UFH) was initiated and re-do TV replacement scheduled...Considering the risks of using bivalirudin or argatroban during cardiopulmonary bypass (CPB), the decision was made to proceed with pre-operative plasmapheresis and use of UFH during CPB. This was facilitated by IV epoprostenol use prior to and during systemic anticoagulation. No complications related to HIT were reported post-operatively."

Clinical • Hematological Disorders • Thrombocytopenia

Tailored Perioperative Approach for High-Risk iPAH Patient Undergoing Hemorrhoidectomy Pre-Lung Transplant (ASA 2025) - "A 51-year-old with BMPR2-associated idiopathic pulmonary arterial hypertension (iPAH) on intravenous epoprostenol, sildenafil, and ambrisentan, awaiting lung transplantation, presented for pre-transplant hemorrhoidectomy...The patient was pretreated with vasopressin and epinephrine; sedation was achieved with midazolam, propofol, and remifentanyl. ECMO and cardiothoracic surgery backup were available. This case highlights perioperative considerations in pre-lung-transplant iPAH patients presenting for non-cardiac surgery."

Clinical • Anesthesia • Cardiovascular • Gastroenterology • Hematological Disorders • Pulmonary Arterial Hypertension • Respiratory Diseases • Thrombocytopenia • Transplantation

Unmasking an Intracardiac Shunt in a Case of Persistent Unexplained Hypoxia: A Case Report. (PubMed, Reports (MDPI)) - "Right heart catheterization (RHC) revealed precapillary pulmonary hypertension (88/37/54 mmHg), prompting the initiation of intravenous epoprostenol. The patient was eventually discharged with a treatment regimen that included subcutaneous Treprostinil. It is important to recognize that the consequences of PH are extensive, and that a rare yet significant etiology for persistent hypoxemia may be attributed to right-to-left shunting."

Journal • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Hypertension • Nephrology • Pulmonary Arterial Hypertension • Pulmonary Disease • Renal Disease • Respiratory Diseases