Background In this multi-centre, randomised, placebo-controlled pilot trial, we investigated the clinical and haemodynamic effects of the endothelin-receptor blocker Bosentan in patients with heart failure, preserved ejection fraction and pulmonary hypertension (PH-HFpEF).Materials and Methods Eligible patients received either 12 weeks of Bosentan therapy, or a placebo drug. Patients were thereafter followed for a further period of 12 weeks without the study medication. At three points during the study (study Commencement, Week 12 and Week 24), a six-minute walk test (6MWT), echocardiographic and laboratory assessments were performed, as well as a quality of life survey. Right heart catheterisation (RHC) was undertaken at commencement only. The study was aborted early, after an interim analysis favoured the placebo.Results Six-minute walk distance (6MWD) did not change in the Bosentan group (309.7 +/- 96.3m (Commencement), 317.0 +/- 126.1m (Week 12), 307.0 +/- 84.4m (Week 24); p = 0.86), but almost reached statistical significance in the placebo group from 328.8 +/- 79.6m, to 361.6 +/- 98.2m and 384.0 +/- 74.9m (Week 24); p = 0.075. In the placebo group, estimated systolic pulmonary artery pressure (measured via echocardiography) significantly decreased (from 62.3 +/- 16.7 mmHg [Commencement], 45.3 +/- 13.9 mmHg [Week 12], to 44.6 +/- 14.5 mmHg [Week 24]; p = 0.014) as did right atrial pressure (13.1 +/- 5.3 [Commencement], 10.0 +/- 3.8 [Week 12], to 9.4 +/- 3.2 [Week 24]; p = 0.046).Conclusion Despite this study's limited sample size and premature cessation, it nevertheless suggests that endothelin receptor blockade in patients with PH-HFpEF may have no beneficial effects and could even be detrimental in comparison to a placebo.

Gastrointestinal obstructive complications after laparoscopic Roux-en-Y gastric bypass (LRYGBP) are not uncommon. Their usual causes are strictures, internal hernias and adhesions. Superior mesenteric artery (SMA) syndrome is a rare disorder caused by compression of the third portion of the duodenum by the SMA that can occur after rapid weight loss. This has been reported in patients with scoliosis, burns, immobilization in body casts, and idiopathic weight loss. SMA syndrome following bariatric surgery has not been reported. We present 3 cases of SMA syndrome after LRYGBP and extensive weight loss. Two patients underwent laparoscopic duodenojejunostomy and the third patient was treated with intravenous hyperalimentation. All three are symptom free at 4-18 months follow-up. The diagnosis of SMA syndrome should be considered in bariatric surgery patients with rapid weight loss who develop atypical, recurrent obstructive symptoms not attributable to other common causes.