Perioperative Management of Pulmonary Hypertension

  • Yuliya B. Goldsmith
  • Natalia Ivascu
  • Dana McGlothlin
  • Paul M. Heerdt
  • Evelyn M. Horn
Part of the Respiratory Medicine book series (RM, volume 12)


Any form of pulmonary hypertension (PH) uniformly increases the perioperative risks of both cardiac and noncardiac surgery. Specific perioperative management of PH patients is dependent upon the etiology and severity of disease as well as the planned operation. A detailed understanding of right ventricular (RV) physiology and the impact of chronic as well as acute-on-chronic PH is paramount to decisions on selection for surgery, preoperative preparation, anesthetic plan and postoperative care. The highest risk PH patients should be referred to PH centers where a multidisciplinary approach to patient care can be planned and where expertise exists in using a multitude of inhaled and systemic pulmonary vasodilators, as well as pharmacological and emergent mechanical interventions for right ventricular failure. This chapter is intended to be a guide for all physicians managing the perioperative care of patients with pulmonary hypertension, with an emphasis on noncardiac surgery.


Pulmonary hypertension Perioperative management Anesthesia High-risk surgery Right ventricle Pulmonary vascular resistance 



Bi-level positive airway pressure


Cardiac index


Continuous positive airway pressure


Deep venous thrombosis


Endothelin receptor antagonists


Eisenmenger’s Syndrome


Heart failure with preserved ejection fraction


Hypoxic pulmonary vasoconstriction


Interstitial lung disease


Inhaled nitric oxide


Left atrial pressure


Left ventricle, left ventricular


Left ventricular end-diastolic pressure


Mean pulmonary artery pressure


Pulmonary artery


Pulmonary arterial hypertension WHO Group 1 PH


Pulmonary artery systolic pressure


Pulmonary capillary wedge pressure


Pulmonary diastolic gradient


Phosphodiesterase 5 inhibitors


Pulmonary embolism


Positive end-expiratory pressure


Pulmonary hypertension


Parts per million


Pulse-pressure variation


Pressure–volume (relationship)


Pulmonary vascular resistance


Right atrial pressure


Right heart catheterization


Right ventricle, right ventricular


Right ventricular hypertrophy


Systemic vascular resistance


Tricuspid annular plane systolic excursion


Transesophageal echocardiography


Transpulmonary gradient


Wood Units


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Yuliya B. Goldsmith
    • 1
    • 2
  • Natalia Ivascu
    • 3
  • Dana McGlothlin
    • 4
  • Paul M. Heerdt
    • 3
    • 5
  • Evelyn M. Horn
    • 1
    • 2
  1. 1.Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Perkin Heart Failure Center, Division of CardiologyWeill Cornell Medical CenterNew YorkUSA
  3. 3.Department of AnesthesiologyWeill Cornell Medical CollegeNew YorkUSA
  4. 4.Department of CardiologyKaiser San Francisco Medical CenterSan FranciscoUSA
  5. 5.Department of PharmacologyWeill Cornell Medical CollegeNew YorkUSA

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