Skip to main content
SpringerLink
Log in

Special Considerations for the Pulmonary Hypertension Patient

  • Chapter
Pulmonary Hypertension

  • 1788 Accesses

Abstract

Practitioners who care for patients with pulmonary hypertension (PH) are often asked to provide expert opinion concerning the optimal management of PH patients in high-risk clinical scenarios. It is imperative that the clinician anticipates the potential complications associated with these events and to provide a comprehensive treatment plan that can be implemented immediately in response to life threatening complications. In this chapter, we will discuss three clinical scenarios that require special consideration as they can be associated with rapid hemodynamic changes that may compromise the capacity of the PH patient to mount an appropriate compensatory physiological response: exercise, pregnancy and surgery. We provide information concerning the physiological changes associated with each of these scenarios and discuss relevant clinical data that will help the practitioner develop a sound treatment plan to effectively deal with specific complications potentially arising in each of these clinical scenarios. It is our goal that this information will help the practitioner institute sound guidelines that will result in improved clinical outcomes for patients with PH.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Desai SA, Channick RN. Exercise in patients with pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2008;28(1):12–6.

    Article  PubMed  Google Scholar 

  2. Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation. 2001;104(4):429–35.

    Article  CAS  PubMed  Google Scholar 

  3. Clark AL, Chua TP, Coats AJ. Anatomical dead space, ventilatory pattern, and exercise capacity in chronic heart failure. Br Heart J. 1995;74(4):377–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Metra M, Dei Cas L, Panina G, Visioli O. Exercise hyperventilation chronic congestive heart failure, and its relation to functional capacity and hemodynamics. Am J Cardiol. 1992;70(6):622–8.

    Article  CAS  PubMed  Google Scholar 

  5. Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P, et al. Development of a ventilatory classification system in patients with heart failure. Circulation. 2007;115(18):2410–7.

    Article  PubMed  Google Scholar 

  6. Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2000;161(2 Pt 1):487–92.

    Article  CAS  PubMed  Google Scholar 

  7. Cenedese E, Speich R, Dorschner L, Ulrich S, Maggiorini M, Jenni R, et al. Measurement of quality of life in pulmonary hypertension and its significance. Eur Respir J. 2006;28(4):808–15.

    Article  CAS  PubMed  Google Scholar 

  8. de Man FS, Handoko ML, Groepenhoff H, Hul AJ V’t, Abbink J, Koppers RJ, et al. Effects of exercise training in patients with idiopathic pulmonary arterial hypertension. Eur Respir J. 2009;34(3):669–75.

    Article  PubMed  Google Scholar 

  9. Grunig E, Maier F, Ehlken N, Fischer C, Lichtblau M, Blank N, et al. Exercise training in pulmonary arterial hypertension associated with connective tissue diseases. Arthritis Res Ther. 2012;14(3):R148.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Grunig E, Lichtblau M, Ehlken N, Ghofrani HA, Reichenberger F, Staehler G, et al. Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J. 2012;40(1):84–92.

    Article  PubMed  Google Scholar 

  11. Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006;114(14):1482–9.

    Article  PubMed  Google Scholar 

  12. Weinstein AA, Chin LM, Keyser RE, Kennedy M, Nathan SD, Woolstenhulme JG, et al. Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med. 2013;107(5):778–84.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Grunig E, Ehlken N, Ghofrani A, Staehler G, Meyer FJ, Juenger J, et al. Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration; Int Rev Thoracic Dis. 2011;81(5):394–401.

    Article  Google Scholar 

  14. Fox BD, Kassirer M, Weiss I, Raviv Y, Peled N, Shitrit D, et al. Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension. J Card Fail. 2011;17(3):196–200.

    Article  PubMed  Google Scholar 

  15. Chan L, Chin LM, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA, et al. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest. 2013;143(2):333–43.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Chung L, Liu J, Parsons L, Hassoun PM, McGoon M, Badesch DB, et al. Characterization of connective tissue disease-associated pulmonary arterial hypertension from REVEAL: identifying systemic sclerosis as a unique phenotype. Chest. 2010;138(6):1383–94.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Clements PJ, Tan M, McLaughlin VV, Oudiz RJ, Tapson VF, Channick RN, et al. The pulmonary arterial hypertension quality enhancement research initiative: comparison of patients with idiopathic PAH to patients with systemic sclerosis-associated PAH. Ann Rheum Dis. 2012;71(2):249–52.

    Article  CAS  PubMed  Google Scholar 

  18. Kabitz HJ, Schwoerer A, Bremer HC, Sonntag F, Walterspacher S, Walker D, et al. Impairment of respiratory muscle function in pulmonary hypertension. Clin Sci. 2008;114(2):165–71.

    Article  CAS  PubMed  Google Scholar 

  19. Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, et al. Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2010;30(5):319–23.

    Article  PubMed  Google Scholar 

  20. Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, et al. Peripheral muscle dysfunction in idiopathic pulmonary arterial hypertension. Thorax. 2010;65(2):113–7.

    Article  PubMed  Google Scholar 

  21. Meyer FJ, Lossnitzer D, Kristen AV, Schoene AM, Kubler W, Katus HA, et al. Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension. Eur Respir J. 2005;25(1):125–30.

    Article  CAS  PubMed  Google Scholar 

  22. Kabitz HJ, Bremer HC, Schwoerer A, Sonntag F, Walterspacher S, Walker DJ, et al. The combination of exercise and respiratory training improves respiratory muscle function in pulmonary hypertension. Lung. 2014;192(2):321–8.

    Article  CAS  PubMed  Google Scholar 

  23. de Man FS, van Hees HW, Handoko ML, Niessen HW, Schalij I, Humbert M, et al. Diaphragm muscle fiber weakness in pulmonary hypertension. Am J Respir Crit Care Med. 2011;183(10):1411–8.

    Article  PubMed  Google Scholar 

  24. Rochester CL, Fairburn C, Crouch RH. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease. Clin Chest Med. 2014;35(2):369–89 [Review].

    Article  PubMed  Google Scholar 

  25. Robson S, Hunter S, Boys R, Dunlop W, Bryson M. Changes in cardiac output during epidural anaesthesia for caesarean section. Anaesthesia. 1989;44(6):475–9.

    Article  CAS  PubMed  Google Scholar 

  26. Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol. 1989;256(4 Pt 2):H1060–5.

    CAS  PubMed  Google Scholar 

  27. Pritchard JA. Changes in the blood volume during pregnancy and delivery. Anesthesiology. 1965;26:393–9.

    Article  CAS  PubMed  Google Scholar 

  28. Clapp 3rd JF, Capeless E. Cardiovascular function before, during, and after the first and subsequent pregnancies. Am J Cardiol. 1997;80(11):1469–73.

    Article  PubMed  Google Scholar 

  29. Ueland K. Maternal cardiovascular dynamics. VII. Intrapartum blood volume changes. Am J Obstet Gynecol. 1976;126(6):671–7.

    CAS  PubMed  Google Scholar 

  30. Pritchard JA. Blood volume changes in pregnancy and the puerperium. Iv. Anemia associated with hydatidiform mole. Am J Obstet Gynecol. 1965;91:621–9.

    CAS  PubMed  Google Scholar 

  31. Lund CJ, Donovan JC. Blood volume during pregnancy. Significance of plasma and red cell volumes. Am J Obstet Gynecol. 1967;98(3):394–403.

    CAS  PubMed  Google Scholar 

  32. McCaffrey RM, Dunn LJ. Primary pulmonary hypertension in pregnancy. Obstet Gynecol Surv. 1964;19:567–91.

    Article  CAS  PubMed  Google Scholar 

  33. Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol. 1998;31(7):1650–7.

    Article  CAS  PubMed  Google Scholar 

  34. Gleicher N, Midwall J, Hochberger D, Jaffin H. Eisenmenger’s syndrome and pregnancy. Obstet Gynecol Surv. 1979;34(10):721–41.

    Article  CAS  PubMed  Google Scholar 

  35. Lieber S, Dewilde P, Huyghens L, Traey E, Gepts E. Eisenmenger’s syndrome and pregnancy. Acta Cardiol. 1985;40(4):421–4.

    CAS  PubMed  Google Scholar 

  36. Jais X, Olsson KM, Barbera JA, Blanco I, Torbicki A, Peacock A, et al. Pregnancy outcomes in pulmonary arterial hypertension in the modern management era. Eur Respir J. 2012;40(4):881–5.

    Article  PubMed  Google Scholar 

  37. Bedard E, Dimopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J. 2009;30(3):256–65.

    Article  PubMed  Google Scholar 

  38. Warnes CA. Pregnancy and pulmonary hypertension. Int J Cardiol. 2004;97 Suppl 1:11–3.

    Article  PubMed  Google Scholar 

  39. Martinez MV, Rutherford JD. Pulmonary hypertension in pregnancy. Cardiol Rev. 2013;21(4):167–73.

    Article  PubMed  Google Scholar 

  40. Hellgren M, Blomback M. Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. I. Normal condition. Gynecol Obstet Invest. 1981;12(3):141–54.

    Article  CAS  PubMed  Google Scholar 

  41. Pechet L, Alexander B. Increased clotting factors in pregnancy. N Engl J Med. 1961;265:1093–7.

    Article  CAS  PubMed  Google Scholar 

  42. American College of O, Gynecologists. ACOG committee opinion: safety of lovenox in pregnancy. Obstet Gynecol. 2002;100(4):845–6.

    Article  Google Scholar 

  43. Bates SM, Greer IA, Hirsh J, Ginsberg JS. Use of antithrombotic agents during pregnancy: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(3 Suppl):627S–44.

    Article  CAS  PubMed  Google Scholar 

  44. Montani D, Gunther S, Dorfmuller P, Perros F, Girerd B, Garcia G, et al. Pulmonary arterial hypertension. Orphanet J Rare Dis. 2013;8:97.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Zamanian RT, Kudelko KT, Sung YK, de Jesus PV, Liu J, Spiekerkoetter E. Current clinical management of pulmonary arterial hypertension. Circ Res. 2014;115(1):131–47.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Zijlstra WM, Ploegstra MJ, Berger RM. Current and advancing treatments for pulmonary arterial hypertension in childhood. Expert Rev Respir Med. 2014;22:1–14.

    Google Scholar 

  47. Archer SL, Michelakis ED. Phosphodiesterase type 5 inhibitors for pulmonary arterial hypertension. N Engl J Med. 2009;361(19):1864–71.

    Article  CAS  PubMed  Google Scholar 

  48. Cannon JE, Pepke-Zaba J. Riociguat for pulmonary hypertension. Exp Rev Clin Pharmacol. 2014;7(3):259–70.

    Article  CAS  Google Scholar 

  49. Conole D, Scott LJ. Riociguat: first global approval. Drugs. 2013;73(17):1967–75.

    Article  CAS  PubMed  Google Scholar 

  50. Casserly B, Klinger JR. Ambrisentan for the treatment of pulmonary arterial hypertension. Drug Des Devel Ther. 2009;2:265–80.

    PubMed Central  PubMed  Google Scholar 

  51. Liu C, Chen J. Endothelin receptor antagonists for pulmonary arterial hypertension. Cochrane Database Syst Rev. 2006;(3):CD004434.

    Google Scholar 

  52. Roberts KE, Preston IR. Safety and tolerability of bosentan in the management of pulmonary arterial hypertension. Drug Des Devel Ther. 2009;3:111–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  53. de Jesus Perez VA. Understanding the pharmacokinetics of oral treprostinil in patients with pulmonary arterial hypertension. J Cardiovasc Pharmacol. 2013;61(6):471–3.

    Article  PubMed  CAS  Google Scholar 

  54. Baradia D, Khatri N, Trehan S, Misra A. Inhalation therapy to treat pulmonary arterial hypertension. Pharmaceut Patent Anal. 2012;1(5):577–88.

    Article  CAS  Google Scholar 

  55. Galie N, Corris PA, Frost A, Girgis RE, Granton J, Jing ZC, et al. Updated treatment algorithm of pulmonary arterial hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D60–72.

    Article  PubMed  Google Scholar 

  56. Olschewski H. Prostacyclins. Handb Exp Pharmacol. 2013;218:177–98.

    Article  CAS  PubMed  Google Scholar 

  57. Sorensen MB, Jacobsen E. Pulmonary hemodynamics during induction of anesthesia. Anesthesiology. 1977;46(4):246–51.

    Article  CAS  PubMed  Google Scholar 

  58. Krenz EI, Hart SR, Russo M, Alkadri M. Epidural anesthesia for cesarean delivery in a patient with severe pulmonary artery hypertension and a right-to-left shunt. Ochsner J. 2011;11(1):78–80.

    PubMed Central  PubMed  Google Scholar 

  59. Manohar MV, Vaidya A, Bakshi S. Revisiting epidural anaesthesia in a parturient with idiopathic pulmonary hypertension posted for caesarean section. Indian J Anaesth. 2014;58(2):235–6.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Maxwell BG, El-Sayed YY, Riley ET, Carvalho B. Peripartum outcomes and anaesthetic management of parturients with moderate to complex congenital heart disease or pulmonary hypertension*. Anaesthesia. 2013;68(1):52–9.

    Article  CAS  PubMed  Google Scholar 

  61. Smedstad KG, Cramb R, Morison DH. Pulmonary hypertension and pregnancy: a series of eight cases. Canadian J Anaesth = Journal canadien d'anesthesie. 1994;41(6):502–12.

    Article  CAS  Google Scholar 

  62. Vongpatanasin W, Brickner ME, Hillis LD, Lange RA. The Eisenmenger syndrome in adults. Ann Intern Med. 1998;128(9):745–55.

    Article  CAS  PubMed  Google Scholar 

  63. Roberts NV, Keast PJ, Brodeky V, Oates A, Ritchie BC. The effects of oxytocin on the pulmonary and systemic circulation in pregnant ewes. Anaesth Intensive Care. 1992;20(2):199–202.

    CAS  PubMed  Google Scholar 

  64. Ross-Ascuitto N, Ascuitto RJ, Darnell J. A pregnant woman with moderate pulmonary hypertension. Pediatr Cardiol. 1995;16(1):31–2.

    Article  CAS  PubMed  Google Scholar 

  65. Thorne S, Nelson-Piercy C, MacGregor A, Gibbs S, Crowhurst J, Panay N, et al. Pregnancy and contraception in heart disease and pulmonary arterial hypertension. J Family Plan Reprod Health Care/Facul Family Plan Reprod Health Care, Royal Coll Obstet Gynaecol. 2006;32(2):75–81.

    Article  Google Scholar 

  66. Taichman DB, Ornelas J, Chung L, Klinger JR, Lewis S, Mandel J, et al. Pharmacologic therapy for pulmonary arterial hypertension in adults: CHEST guideline and expert panel report. Chest. 2014;146(2):449–75.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Safdar Z. Pulmonary arterial hypertension in pregnant women. Ther Adv Respir Dis. 2013;7(1):51–63 [Research Support, N.I.H., Extramural Review].

    Article  PubMed  CAS  Google Scholar 

  68. Reich DL, Wood Jr RK, Emre S, Bodian CA, Hossain S, Krol M, et al. Association of intraoperative hypotension and pulmonary hypertension with adverse outcomes after orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2003;17(6):699–702.

    Article  PubMed  Google Scholar 

  69. Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardio-thoracic Surgery : Off J Eur Assoc Cardio-thoracic Surg. 1999;15(6):816–22. [Multicenter Study Research Support, Non-U.S. Gov’t]; discussion 22–3.

    Article  CAS  Google Scholar 

  70. Ramakrishna G, Sprung J, Ravi BS, Chandrasekaran K, McGoon MD. Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality. J Am Coll Cardiol. 2005;45(10):1691–9.

    Article  PubMed  Google Scholar 

  71. Lai HC, Lai HC, Wang KY, Lee WL, Ting CT, Liu TJ. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. Br J Anaesth. 2007;99(2):184–90 [Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  72. McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol. 2009;53(17):1573–619 [Consensus Development Conference Practice Guideline].

    Article  PubMed  Google Scholar 

  73. Meyer S, McLaughlin VV, Seyfarth HJ, Bull TM, Vizza CD, Gomberg-Maitland M, et al. Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey. Eur Respir J. 2013;41(6):1302 [Multicenter Study].

    Article  PubMed  Google Scholar 

  74. Kaw R, Pasupuleti V, Deshpande A, Hamieh T, Walker E, Minai OA. Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery. Respir Med. 2011;105(4):619–24 [Comparative Study].

    Article  PubMed  Google Scholar 

  75. Hosseinian L. Pulmonary hypertension and noncardiac surgery: implications for the anesthesiologist. J Cardiothorac Vasc Anesth. 2014;28(4):1076–86 [Review].

    Article  Google Scholar 

  76. McGlothlin D, Ivascu N, Heerdt PM. Anesthesia and pulmonary hypertension. Prog Cardiovasc Dis. 2012;55(2):199–217 [Review].

    Article  PubMed  Google Scholar 

  77. Price LC, Montani D, Jais X, Dick JR, Simonneau G, Sitbon O, et al. Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension. Eur Respir J. 2010;35(6):1294–302 [Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed  Google Scholar 

  78. Fischer LG, Van Aken H, Burkle H. Management of pulmonary hypertension: physiological and pharmacological considerations for anesthesiologists. Anesth Analg. 2003;96(6):1603–16 [Research Support, Non-U.S. Gov’t Review].

    Article  PubMed  Google Scholar 

  79. Strumpher J, Jacobsohn E. Pulmonary hypertension and right ventricular dysfunction: physiology and perioperative management. J Cardiothorac Vasc Anesth. 2011;25(4):687–704 [Review].

    Article  PubMed  Google Scholar 

  80. Tonelli AR, Minai OA. Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: perioperative management in patients with pulmonary hypertension. Ann Thorac Med. 2014;9 Suppl 1:S98–107.

    PubMed Central  PubMed  Google Scholar 

  81. McLaughlin VV, Presberg KW, Doyle RL, Abman SH, McCrory DC, Fortin T, et al. Prognosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004;126(1 Suppl):78S–92 [Guideline Practice Guideline Review].

    Article  PubMed  Google Scholar 

  82. Lahm T, McCaslin CA, Wozniak TC, Ghumman W, Fadl YY, Obeidat OS, et al. Medical and surgical treatment of acute right ventricular failure. J Am Coll Cardiol. 2010;56(18):1435–46 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t Review].

    Article  PubMed  Google Scholar 

  83. Thunberg CA, Gaitan BD, Grewal A, Ramakrishna H, Stansbury LG, Grigore AM. Pulmonary hypertension in patients undergoing cardiac surgery: pathophysiology, perioperative management, and outcomes. J Cardiothorac Vasc Anesth. 2013;27(3):551–72 [Review].

    Article  PubMed  Google Scholar 

  84. Zamanian RT, Haddad F, Doyle RL, Weinacker AB. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med. 2007;35(9):2037–50 [Research Support, Non-U.S. Gov’t Review].

    Article  PubMed  Google Scholar 

  85. Humbert M, Sitbon O, Simonneau G. Treatment of pulmonary arterial hypertension. N Engl J Med. 2004;351(14):1425–36 [Research Support, Non-U.S. Gov’t Review].

    Article  CAS  PubMed  Google Scholar 

  86. Lang I, Gomez-Sanchez M, Kneussl M, Naeije R, Escribano P, Skoro-Sajer N, et al. Efficacy of long-term subcutaneous treprostinil sodium therapy in pulmonary hypertension. Chest. 2006;129(6):1636–43 [Clinical Trial Multicenter Study Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed  Google Scholar 

  87. McLaughlin VV, Shillington A, Rich S. Survival in primary pulmonary hypertension: the impact of epoprostenol therapy. Circulation. 2002;106(12):1477–82 [Clinical Trial Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed  Google Scholar 

  88. Sitbon O, Humbert M, Nunes H, Parent F, Garcia G, Herve P, et al. Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival. J Am Coll Cardiol. 2002;40(4):780–8 [Clinical Trial Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed  Google Scholar 

  89. Barst RJ, Galie N, Naeije R, Simonneau G, Jeffs R, Arneson C, et al. Long-term outcome in pulmonary arterial hypertension patients treated with subcutaneous treprostinil. Eur Respir J. 2006;28(6):1195–203 [Comparative Study Randomized Controlled Trial].

    Article  CAS  PubMed  Google Scholar 

  90. Sadushi-Kolici R, Skoro-Sajer N, Zimmer D, Bonderman D, Schemper M, Klepetko W, et al. Long-term treatment, tolerability, and survival with sub-cutaneous treprostinil for severe pulmonary hypertension. J Heart Lung Transplant: Off Publ Int Soc Heart Transplant. 2012;31(7):735–43 [Research Support, Non-U.S. Gov’t].

    Article  Google Scholar 

  91. Barst RJ, Rubin LJ, McGoon MD, Caldwell EJ, Long WA, Levy PS. Survival in primary pulmonary hypertension with long-term continuous intravenous prostacyclin. Ann Intern Med. 1994;121(6):409–15 [Clinical Trial Multicenter Study Research Support, Non-U.S. Gov’t Research Support, P.H.S.].

    Article  CAS  PubMed  Google Scholar 

  92. Chin KM, Channick RN, de Lemos JA, Kim NH, Torres F, Rubin LJ. Hemodynamics and epoprostenol use are associated with thrombocytopenia in pulmonary arterial hypertension. Chest. 2009;135(1):130–6.

    Article  CAS  PubMed  Google Scholar 

  93. Tamburrelli C, Crescente M, Izzi B, Barisciano M, Donati MB, de Gaetano G, et al. Epoprostenol inhibits human platelet-leukocyte mixed conjugate and platelet microparticle formation in whole blood. Thromb Res. 2011;128(5):446–51 [Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed  Google Scholar 

  94. Ardehali A, Hughes K, Sadeghi A, Esmailian F, Marelli D, Moriguchi J, et al. Inhaled nitric oxide for pulmonary hypertension after heart transplantation. Transplantation. 2001;72(4):638–41.

    Article  CAS  PubMed  Google Scholar 

  95. De Wet CJ, Affleck DG, Jacobsohn E, Avidan MS, Tymkew H, Hill LL, et al. Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery. J Thorac Cardiovasc Surg. 2004;127(4):1058–67 [Clinical Trial Comparative Study Research Support, Non-U.S. Gov’t].

    Article  PubMed  CAS  Google Scholar 

  96. Fattouch K, Sbraga F, Sampognaro R, Bianco G, Gucciardo M, Lavalle C, et al. Treatment of pulmonary hypertension in patients undergoing cardiac surgery with cardiopulmonary bypass: a randomized, prospective, double-blind study. J Cardiovasc Med. 2006;7((2):119–23 [Comparative Study Randomized Controlled Trial].

    Article  Google Scholar 

  97. Lamarche Y, Perrault LP, Maltais S, Tetreault K, Lambert J, Denault AY. Preliminary experience with inhaled milrinone in cardiac surgery. Eur J Cardiothorac Surg: Off J Eur Assoc Cardiothorac Surg. 2007;31(6):1081–7 [Research Support, Non-U.S. Gov’t].

    Article  Google Scholar 

  98. Rex S, Schaelte G, Metzelder S, Flier S, de Waal EE, Autschbach R, et al. Inhaled iloprost to control pulmonary artery hypertension in patients undergoing mitral valve surgery: a prospective, randomized-controlled trial. Acta Anaesthesiol Scand. 2008;52(1):65–72 [Comparative Study Randomized Controlled Trial].

    Article  CAS  PubMed  Google Scholar 

  99. Winterhalter M, Simon A, Fischer S, Rahe-Meyer N, Chamtzidou N, Hecker H, et al. Comparison of inhaled iloprost and nitric oxide in patients with pulmonary hypertension during weaning from cardiopulmonary bypass in cardiac surgery: a prospective randomized trial. J Cardiothorac Vasc Anesth. 2008;22(3):406–13 [Comparative Study Randomized Controlled Trial].

    Article  CAS  PubMed  Google Scholar 

  100. Miller OI, Tang SF, Keech A, Celermajer DS. Rebound pulmonary hypertension on withdrawal from inhaled nitric oxide. Lancet. 1995;346(8966):51–2 [Comparative Study Letter Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed  Google Scholar 

  101. Namachivayam P, Theilen U, Butt WW, Cooper SM, Penny DJ, Shekerdemian LS. Sildenafil prevents rebound pulmonary hypertension after withdrawal of nitric oxide in children. Am J Respir Crit Care Med. 2006;174(9):1042–7 [Randomized Controlled Trial].

    Article  CAS  PubMed  Google Scholar 

  102. Linde LM, Simmons DH, Lewis N. Pulmonary hemodynamics in respiratory acidosis in dogs. Am J Physiol. 1963;205(5):1008–12.

    CAS  PubMed  Google Scholar 

  103. Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000;4(5):302–8 [Clinical Trial Controlled Clinical Trial Research Support, Non-U.S. Gov’t].

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  104. But AK, Ozgul U, Erdil F, Gulhas N, Toprak HI, Durmus M, et al. The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand. 2006;50(10):1207–12 [Randomized Controlled Trial].

    Article  CAS  PubMed  Google Scholar 

  105. Price LC, Wort SJ, Finney SJ, Marino PS, Brett SJ. Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review. Crit Care. 2010;14(5):R169 [Research Support, Non-U.S. Gov’t Review].

    Article  PubMed Central  PubMed  Google Scholar 

  106. Rajdev A, Garan H, Biviano A. Arrhythmias in pulmonary arterial hypertension. Prog Cardiovasc Dis. 2012;55(2):180–6 [Review].

    Article  PubMed  Google Scholar 

  107. Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, et al. Part 8: advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010;122(16 Suppl 2):S345–421 [Consensus Development Conference Practice Guideline].

    Article  PubMed  Google Scholar 

  108. Minai OA, Venkateshiah SB, Arroliga AC. Surgical intervention in patients with moderate to severe pulmonary arterial hypertension. Conn Med. 2006;70(4):239–43.

    PubMed  Google Scholar 

  109. Fox C, Kalarickal PL, Yarborough MJ, Jin JY. Perioperative management including new pharmacological vistas for patients with pulmonary hypertension for noncardiac surgery. Curr Opin Anaesthesiol. 2008;21(4):467–72 [Review].

    Article  PubMed  Google Scholar 

  110. McGlothlin D, De Marco T. Preoperative risk assessment of pulmonary arterial hypertension patients undergoing general surgery. Adv Pulm Hypertens. 2007;6(3):66–73.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care, Stanford University Medical Center, 300 Pasteur Road, Stanford, CA, 94305, USA

    Kristina T. Kudelko MD, Roham T. Zamanian MD & Vinicio A. De Jesus Perez MD

  2. Department of Medicine, Stanford University, Stanford, CA, USA

    Kristina T. Kudelko MD

  3. Department of Medicine, Stanford University Medical Center, Stanford, CA, USA

    Vinicio A. De Jesus Perez MD

Authors
  1. Kristina T. Kudelko MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roham T. Zamanian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vinicio A. De Jesus Perez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristina T. Kudelko MD .

Editor information

Editors and Affiliations

  1. Cardiovascular Medicine Dept, Harvard Medical School Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Bradley A. Maron

  2. Pulmonary & Critical Care Medicine, Stanford University Medical Center, Stanford, California, USA

    Roham T. Zamanian

  3. Pulmonary Critical Care Medicine Dept Cardiovascular Medicine Dept, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA

    Aaron B. Waxman

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Kudelko, K.T., Zamanian, R.T., De Jesus Perez, V.A. (2016). Special Considerations for the Pulmonary Hypertension Patient. In: Maron, B., Zamanian, R., Waxman, A. (eds) Pulmonary Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-23594-3_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-23594-3_22

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23593-6

  • Online ISBN: 978-3-319-23594-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation