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)

Abstract

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.

Keywords

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

Abbreviations

BiPAP

Bi-level positive airway pressure

CI

Cardiac index

CPAP

Continuous positive airway pressure

DVT

Deep venous thrombosis

ERA

Endothelin receptor antagonists

ES

Eisenmenger’s Syndrome

HFpEF

Heart failure with preserved ejection fraction

HPV

Hypoxic pulmonary vasoconstriction

ILD

Interstitial lung disease

iNO

Inhaled nitric oxide

LAP

Left atrial pressure

LV

Left ventricle, left ventricular

LVEDP

Left ventricular end-diastolic pressure

mPAP

Mean pulmonary artery pressure

PA

Pulmonary artery

PAH

Pulmonary arterial hypertension WHO Group 1 PH

PASP

Pulmonary artery systolic pressure

PCWP

Pulmonary capillary wedge pressure

PDG

Pulmonary diastolic gradient

PDE5-I

Phosphodiesterase 5 inhibitors

PE

Pulmonary embolism

PEEP

Positive end-expiratory pressure

PH

Pulmonary hypertension

Ppm

Parts per million

PPV

Pulse-pressure variation

PV

Pressure–volume (relationship)

PVR

Pulmonary vascular resistance

RAP

Right atrial pressure

RHC

Right heart catheterization

RV

Right ventricle, right ventricular

RVH

Right ventricular hypertrophy

SVR

Systemic vascular resistance

TAPSE

Tricuspid annular plane systolic excursion

TEE

Transesophageal echocardiography

TPG

Transpulmonary gradient

WU

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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