Inflammatory Basis of Pulmonary Arterial Hypertension Implications for Perioperative and Critical Care Medicine

Pulmonary hypertension, defined as a resting mean pulmonary artery pressure greater than or equal to 25 mmHg, results from a myriad of conditions. The Fifth World Symposium on Pulmonary Hypertension proposed a classification system that organizes pulmonary hypertension into five groups based on common hemodynamic, pathophysiologic, and therapeutic parameters.1 This review focuses on pulmonary arterial hypertension (Group 1 pulmonary hypertension), a disease in which progressive pulmonary vascular obstruction, remodeling, and destruction lead to increased right ventricular afterload and hypertrophy, right heart failure, and death. On a cellular level, the dysregulated proliferation of endothelial, smooth muscle, and immune cells predominates within the diseased vessels.2 Hemodynamically, pulmonary arterial hypertension can be defined as a mean pulmonary artery pressure greater than 25 mmHg, a pulmonary capillary wedge pressure less than 15 mmHg, and a pulmonary vascular resistance (PVR) greater than 3 Wood units in the absence of a more common cause such as left heart disease, chronic venothromboembolic disease, or lung disease. Like pulmonary hypertension in general, pulmonary arterial hypertension can result from multiple causes, including infectious and autoimmune pathologies. In this review, our focus will be on pulmonary arterial hypertension specifically (World Health Organization Group 1), predominantly comprising idiopathic and heritable pulmonary arterial hypertension...
Source: Anesthesiology - Category: Anesthesiology Source Type: research