Dramatic functional improvement following bariatric surgery in a patient with pulmonary arterial hypertension and morbid obesity.

Pulmonary arterial hypertension (PAH) and morbid obesity both dramatically impair functional capacity. New therapies have emerged for both conditions, including pharmaceutical agents for the former and bariatric surgery for the latter. The presence of both conditions simultaneously, however, may limit the applicability and effectiveness of these therapies. We report a case of a morbidly obese patient with severe PAH and functional impairment. A three-drug combination regimen consisting of oral bosentan and sildenafil, and inhaled iloprost produced sufficient hemodynamic improvement to allow for the performance of bariatric surgery. Over the subsequent 7 months, body weight, oxygen requirement, functional class, and 6-min walk distance all improved dramatically despite the persistence of PAH. While such surgery is typically denied to patients with PAH, we suggest that aggressive medical therapy for patients with PAH may allow for its safe performance, and that the clinical improvement resulting from the subsequent weight loss may be quite dramatic.