Abstract
Pulmonary hypertension is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality. With the aging population and the associated increase severity of illness, the prevalence of pulmonary hypertension in cardiac surgical patients will increase. In this review, the definition of pulmonary hypertension, the mechanisms and its relationship to right ventricular dysfunction will be presented. Finally, pharmacological and non-pharmacological therapeutic and preventive approaches will be presented.
Highlights
DEFINITION OF PULMONARY HYPERTENSIONThere are several hemodynamic parameters that are used in defining pulmonary hypertension (PHT) (Table 1) [1]
Pulmonary hypertension is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality
We first demonstrated that the induction of general anesthesia in 32 patients was associated with a significant reduction in mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP) but the MAP/MPAP ratio did not change (Fig. 2)
Summary
There are several hemodynamic parameters that are used in defining pulmonary hypertension (PHT) (Table 1) [1]. We first demonstrated that the induction of general anesthesia in 32 patients was associated with a significant reduction in mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP) but the MAP/MPAP ratio did not change (Fig. 2) This ratio (normal value > 4) seems to be a very robust estimator of the severity of PHT. The 2003 World Symposium on PHT proposed a classification based on 5 groups: 1-Pulmonary arterial hypertension, 2-PHT secondary to left heart disease, 3-PHT secondary to lung disease and/or hypoxia, 4PHT secondary to thrombotic and/or embolic disease and 5A miscellaneous category [6] In cardiac surgery, it is typically post-capillary or group 2 because the cause of PHT is of cardiac origin and localized after the pulmonary capillary. In patients under general anesthesia, the relative value seems to be more appropriate
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