[Unusual cause of right heart failure decompensation in 21-years old patient with idiopathic pulmonary arterial hypertension -- a case report]. / Nietypowa przyczyna zaostrzenia prawokomorowej niewydolnosci serca u 21-letniej pacjentki z idiopatycznym nadcisnieniem plucnym - opis przypadku.

The authors describe a case of 21-years old woman with idiopathic pulmonary arterial hypertension with atypical clinical consequences of massive internal bleeding. Despite significant hypovolemia clinical and laboratory presentation was one of RV failure with dilatation of right heart ventricle and increased plasma level of markers of myocardial stretch and injury (NT-proBNP and troponin, respectively). This is attributed to impaired right ventricular coronary perfusion and hypoxia. Intensive treatment restored baseline RV conditions and at 15 months follow-up no persistent right heart impairment was observed. This case demonstrates that bleeding should be also considered in differential diagnosis of exacerbation of right ventricular failure in patients with pulmonary arterial hypertension.

[Pulmonary thrombendarterectomy in a patient with chronic thromboembolic pulmonary hypertension (CTEPH) and chronic renal failure due to diabetic nephropathy--case report]. / Trombendarterektomia plucna u chorego z zakrzepowo-zatorowym nadcisnieniem plucnym (CTEPH) i przewlekla niewydolnoscia nerek w przebiegu nefropatii cukrzycowej--opis przypadku.

A case of 63-years old man suffering from CTEPH and chronic renal failure due to diabetic nephropathy is presented. First diagnosis of pulmonary hypertension was made at the beginning of 2000. Then the secondary anticoagulant prophylaxis were introduced. Despite such treatment there was no improvement and level of pulmonary hypertension increased. Finally, the pulmonary thrombectomy was considered because of proximal location of thromboembolic obstruction in pulmonary artery. Before surgery, the hemodialysis was started. Pulmonary thrombendarterectomy along with right coronary artery bypass grafting were performed in November 2001. The procedure was conducted successfully. The patient's condition improved and pulmonary pressure dropped substantially. During follow-up anticoagulant prophylaxis and hemodialysis are continued. It might be conducted that pulmonary thrombendarterectomy can be successfully performed also in patients with complex coexisting conditions.