Pulmonary Hypertension and Thoracic Surgery: Impact and Treatment Options

AbstractPurpose of ReviewThe purpose of this paper is to review updates to the definition of pulmonary hypertension (PH), its diagnosis, and management. New treatment options, the role of mechanical support, outcome studies, and intraoperative management will be emphasized.Recent FindingsThe definition of PH has been recently changed, with a decrease in the qualifying mean pulmonary artery pressure and the addition of pulmonary vascular resistance. There have been minor changes to PH classifications. Some new medications are available to treat PH, and new associations between drugs and PH have been discovered. Recommended intraoperative management strategies are included. Updated outcome studies are discussed, as well as the potential role of mechanical devices for managing PH patients during or after thoracic surgery.SummaryPulmonary hypertension (PH) comprises a complex group of pathologies that can be difficult to identify and care for perioperatively. Caring for patients with PH requires cardiovascular management expertise, familiarity with medicines used to treat PH, and the ability to accurately interpret diagnostic data and hemodynamic monitors.
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research

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Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperativ...
Source: Revista Brasileira de Cirurgia Cardiovascular - Category: Cardiovascular & Thoracic Surgery Source Type: research
Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperativ...
Source: Revista Brasileira de Cirurgia Cardiovascular - Category: Cardiovascular & Thoracic Surgery Source Type: research
Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperativ...
Source: Revista Brasileira de Cirurgia Cardiovascular - Category: Cardiovascular & Thoracic Surgery Source Type: research
PERIOPERATIVE transesophageal echocardiography (TEE) is, at its core, the art and science of interpreting clinical images and making decisions. In this endeavor, the guidelines often are helpful. There are times, however, when you come across a case that is not what you would describe as routine, and it makes you pause and ponder. Songster et al., in their E-challenge, titled “Pulmonary Artery Stenosis in a Patient with Prior Histoplasmosis and the Discovery of Complications,” report on just such a case of a patient with pulmonary hypertension caused by external compression of the pulmonary vasculature.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
Pulmonary hypertension (PH) is a substantial preoperative risk factor. For this study, morbidity and mortality were examined after noncardiac surgery in patients with precapillary PH.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
Pulmonary hypertension (PH) results from varied etiologies, leading to progressive symptoms and limiting physical activity and quality of life, with associated morbidity and mortality. External compression of the pulmonary artery (PA) is a rare cause of PH and may give the clinician cause to investigate compression of nearby structures. In this E-Challenge, the authors present a case of PA stenosis in a patient with prior histoplasmosis scheduled for left PA stenting. However, because the pulmonary veins were not well-visualized on chest computed tomography, the anesthesia team performed a perioperative transesophageal ech...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: E-Challenges & Clinical Decisions Source Type: research
CONCLUSIONS: Our experience suggested that rapid uptitration of intravenous treprostinil combined with oral sildenafil in the postpartum period may be a safe and effective approach for these very sick parturients with severe pulmonary hypertension. PMID: 31743181 [PubMed - in process]
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Recently, we identified a wider metabolic reprogramming in lung tissue in a rodent model of PAH [Front Cardiovasc Med 2018: 5: 110]. Specifically, aberrant choline metabolism was identified as a feature of cell proliferation, representing a new therapeutic target for PAH. The aim of this study is the in-vivo monitoring of choline metabolism in a rat model of PAH by Positron Emission Tomography (PET) imaging.Methods: PAH was induced in male Sprague Dawley rats (MCT group) by a single injection of Crotaline (C2401, Sigma-Aldrich). Three weeks after administration, MCT and controls rats were subjected to [11C]Choline PET imag...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Pulmonary hypertension Source Type: research
Conclusion: Despite normalization of MAO-A activity in PTB rats, no functional improvements or changes in cardiac size were observed. Histological analyses will further elucidate these findings.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Pulmonary hypertension Source Type: research
Introduction: PH is common in the sicker subsets of ILD. ILD transbronchial cryobiopsy (ILD-C) guidelines (Hetzel 2018, Dhooria et al 2019) mention PH [echocardiographic pulmonary artery pressure (PASP)> 40mmHg] as a relative contraindication (RC) due to risk of bleeding and worsening hypoxemia. These recommendations are extrapolated from surgical sampling.Aim: We analysed ILD-C high-PH (PASP> 40mmHg) in real world situations, and the role of pre-optimization in facilitating ILD-C in this group, otherwise contraindicated for ILD-C.Methods: Retrospective review of 150 ILD-C procedures, identifying patients with PASP&g...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional pulmonology Source Type: research
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