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The Early Bird Rises to the Challenge

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Anders Andreasson, MD
Freeman Hospital
Newcastle upon Tyne, UK

Friday at daybreak, I tiptoed over to San Diego Bay in a dreamlike peaceful manner. Why am I up so early? It's highly recommended for anyone travelling internationally who is expected to show up at work attentive and alert at 7 a.m. to "jet lag" yourself a little bit with a preparatory long-haul flight 1-2 days in advance. So as I was listening to birds singing during my morning jog at 5 a.m. I knew I was in fact jetlagged. However, I knew this was not going to keep me from attending an early morning session as I get to experience cutting edge discussions in my medical field. In fact, if there are any headhunters out there looking for a nomadic surgical trainee for a split-week post in Europe/North America/Asia, I am your man!

Back to the topic at hand. A complete North American roster of junior presenters and senior experts showed up notably rested, prepared and eager for the kickoff Sunrise Symposium 2: Under too much Pressure: Challenging Cases in Pulmonary Hypertension Management. With three well-selected cases of challenging pulmonary hypertension patients, the junior physicians succeeded with the difficult task of setting up for a very fruitful yet early discussion between the invited expert panel and early bird specialists in the auditorium.

Dr. Amit Banga from Cleveland presented a case depicting the difficulties of combatting high PVRs in hypertrophic cardiomyopathy transplant candidates. This was skillfully tackled by the senior colleague Dr. Adaani Frost on the topic of balancing right and left ventricular function and clearly defining the cause of the pulmonary hypertension to be able to target the intervention toward preload, afterload, or the pulmonary vasculature.

Dr. Kerri Akaya Smith then presented a case of the ill-defined patient group suffering from pulmonary hypertension at exertion, with a following discussion and consensus on the appropriateness of not hurrying with the diagnosis labeling in these often otherwise healthy patients, but to instead offer a generous follow-up strategy.

Finally, Dr. Mitesh Thakrar from Calgary portrayed the challenges in the optimization of patients awaiting a liver transplant with pulmonary hypertension, with the balance between hypo perfusion, control of the pulmonary hypertension and vascular resistance, and the occasional massive cardiac output seen in these patients with port pulmonary hypertension. Well done Docs, a 5+ symposium!

Disclosure Statement: the author has no conflicts of interest to report.

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