Pulmonary hypertension and major surgery.

Abstract

P atients with pulmonary hypertension have markedly increased morbidity and mortality with anesthesia and surgery (1,2). For patients with Eisenmenger’s syndrome undergoing cesarean section, mortality is 46%70”/0 (3). The risks associated with primary pulmonary hypertension (PPH) seem to be even more frequent than those related to secondary pulmonary hypertension (4). Reports of successful outcomes of surgery in patients with primary pulmonary hypertension include curative procedures such as lung or heart-lung transplantation, cesarean section (2,3), and relatively brief procedures with minor blood loss and fluid shifts (lung biopsy, cholecystectomy, femoral artery repair, and laparoscopic tubal ligation) (5-9). The following case report describes a patient with PPH who successfully underwent combined abdominal aortic aneurysmectomy and hysterectomy. This case report emphasizes the value of preoperative pulmonary vasodilator testing to determine the risks of anesthesia and surgery and to provide a therapeutic option in the perioperative period. In this case report, we also discuss an approach to postoperative management of these patients.