Interventional and surgical modalities of treatment in pulmonary hypertension.
Most patients with chronic thromboembolic pulmonary hypertension are operable, and pulmonary endarterectomy is the treatment of choice. Pulmonary endarterectomy should not be delayed for medical therapy, and risk stratification helps to define patients likely to achieve the best outcome. Inoperable patients should be referred for trials of medical agents. Atrial septostomy is promising but underutilized, although better ways of ensuring an adequate, lasting septostomy still need to be determined. Indications for the procedure are unchanged, and it should be considered more frequently. Bilateral sequential lung or heart-lung transplantation is an important option for selected patients, and potential candidates who are class IV or III but not improving should be referred early to a transplantation center. Currently, there is a need for right ventricular assist devices with flow characteristics suited to the circulation of patients with pulmonary arterial hypertension. Right ventricular synchronization therapy has not yet been tested. Novel shunts (e.g., Potts anastomosis) also hold promise. All surgery for pulmonary hypertension should be performed in centers with experience in these techniques.
Keogh
Anne M
AM
St. Vincent's Hospital, Sydney, Australia. Electronic address: amkeogh@stvincents.com.au.
Mayer
Eckhard
E
Catholic Academic Hospital, Mainz, Germany.
Benza
Raymond L
RL
Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Corris
Paul
P
Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Dartevelle
Philippe G
PG
Marie Lannelongue Hospital, Le Plessis Robinson, France.
Frost
Adaani E
AE
Baylor College of Medicine, Houston, Texas.
Kim
Nick H
NH
University of California, San Diego, School of Medicine, La Jolla, California.
Lang
Irene M
IM
Medical University of Vienna, Vienna, Austria.
Pepke-Zaba
Joanna
J
Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
Sandoval
Julio
J
National Institute of Cardiology, Mexico City, Mexico.
D004691:Endarterectomy; D006333:Heart Failure / Q000209:etiology; D006353:Heart-Assist Devices; D016041:Heart-Lung Transplantation; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000601:surgery / Q000628:therapy*; D008020:Life Support Care; D016040:Lung Transplantation; D011651:Pulmonary Artery / Q000601:surgery*; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed