Pulmonary Resection in the Patient with Pulmonary Hypertension

  • Alexander HuangEmail author
  • Katherine Marseu


Pulmonary hypertension is a significant medical condition, with a global prevalence estimated as high as 1%. As such, it is no longer an uncommon occurrence for patients with pulmonary hypertension to present for surgery. Pulmonary resection in the patient with pulmonary hypertension has long been considered high risk and discouraged in early literature. The morbidity and mortality associated with pulmonary hypertension in patients presenting for surgery have been quoted as high as 42% and 18%, respectively. In this chapter, we review the perioperative management of patients with pulmonary hypertension presenting for pulmonary resection. This includes the preoperative assessment, pharmacology as it relates to pulmonary hypertension (both preoperative and intraoperative), anesthetic management (including management intraoperatively, monitoring, and a discussion of ventilation and analgesic strategies), and postoperative care. An example clinical case is presented at the end of the chapter to integrate this information.


Pulmonary hypertension Pulmonary resection Lung resection Lobectomy Pneumonectomy Segmentectomy Pulmonary vascular resistance Pulmonary arterial pressure Pulmonary artery catheter Transesophageal echocardiography One-lung ventilation 



Acute respiratory distress syndrome




Extracorporeal membrane oxygenation


Endothelin receptor antagonist


Inhaled nitric oxide


New York Heart Association


One-lung ventilation


Pulmonary artery catheter

PAP or PA pressure

Pulmonary artery pressure


Patient-controlled analgesia






Right heart catheterization


Right ventricular systolic pressure


Systolic pulmonary artery pressure


Transesophageal echocardiography


Transthoracic echocardiography


Video-assisted thoracoscopic surgery


World Health Organization


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Anesthesia and Pain ManagementToronto General Hospital, University Health Network and University of TorontoTorontoCanada

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