title: Management of peri-operative pulmonary hypertension in a patient presenting for a portosystemic shunt.
abstract: We report the successful management of intra-operative pulmonary hypertension in a patient with mitral valve insufficiency and portal hypertension. A 48-year-old male with portal hypertension presented for a portosystemic shunt. Previously undiagnosed mitral valve insufficiency and pulmonary hypertension complicated his anaesthetic management. His intra-operative course was marked by systolic hypotension, pulmonary hypertension and a reduction in cardiac output. The use of nitric oxide in this patient reduced right ventricular afterload, increased cardiac output, without exacerbating pre-existing systolic hypotension.
authors.affiliation: Département d'Anesthésie-Réanimation, Centre Hospitalier, Universitaire de Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: B
authors.initials: B
authors.lastname: Kinirons
authors.forename: L
authors.initials: L
authors.lastname: Kuhlman
authors.forename: K
authors.initials: K
authors.lastname: Mori
authors.forename: K
authors.initials: K
authors.lastname: Samii
mesh_terms: D000758:Anesthesia / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007022:Hypotension / Q000209:etiology; D007431:Intraoperative Complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis; D009569:Nitric Oxide / Q000627:therapeutic use; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide