Hypoxic pulmonary vasoconstriction in cardiothoracic surgery: basic mechanisms to potential therapies.
Hypoxic pulmonary vasoconstriction is postulated to be an adaptive mechanism to match lung perfusion with ventilation; however, the consequences of the maladaptive effects of pulmonary vasoconstriction represent formidable therapeutic challenges. Understanding the basic mechanisms of hypoxic pulmonary vasoconstriction will enhance the assimilation of translational research into clinical practice. The purposes of this review are to (1) define basic mechanisms of pulmonary vasoconstriction and vasorelaxation; (2) delineate the biphasic contractile response to hypoxia; (3) critically examine data that support the mediator hypothesis versus the ion channel hypothesis; and (4) explore potential mechanistic-based therapies for hypoxic pulmonary vasoconstriction.
Tsai
Ben M
BM
Section of Cardiothoracic Surgery, Department of Surgery, Indianapolis, Indiana, USA.
Wang
Meijing
M
Turrentine
Mark W
MW
Mahomed
Yousuf
Y
Brown
John W
JW
Meldrum
Daniel R
DR
D000222:Adaptation, Physiological; D000328:Adult; D000818:Animals; D006348:Cardiac Surgical Procedures; D002648:Child; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology* / Q000628:therapy; D008954:Models, Biological; D009569:Nitric Oxide / Q000502:physiology; D010100:Oxygen / Q000627:therapeutic use; D015221:Potassium Channels / Q000502:physiology; D011453:Prostaglandins / Q000502:physiology; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation; D051381:Rats; D012128:Respiratory Distress Syndrome / Q000209:etiology; D013564:Sympathetic Nervous System / Q000503:physiopathology; D014661:Vasoconstriction / Q000502:physiology*
D015221:Potassium Channels; D011453:Prostaglandins; D009569:Nitric Oxide; D010100:Oxygen