Pulmonary hypertension surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Richard Channick, M.D.; Assistant Editor(s)-in-Chief: Ralph Matar; Lisa Prior; Ann Slater, R.N.; Rim Halaby, M.D. [2]

Overview

Patients with severe WHO functional class II or III pulmonary hypertension (PH) refractory to medical therapy are candidate for surgical intervention, such as atrial septostomy or lung transplantation. Pulmonary thromboendarterectomy (PTE) is a surgical procedure that is used for chronic thromboembolic pulmonary hypertension.

Surgery

Surgical intervention such as atrial septostomy or lung transplantation should be considered among patients with pulmonary arterial hypertension (PAH) who fail to improve on optimal therapy or when medical therapy is unavailable.[1]

Failure of clinical improvement among PAH patients with WHO functional class II or III is defined as either:[1]

  • A stable and unsatisfactory clinical status, or
  • An unstable and deteriorating

Failure of clinical improvement among PAH patients with WHO functional class IV is defined as either:[1]

  • Absence of quick improvement to a WHO functional class III or less, or
  • A stable and unsatisfactory clinical status

Atrial Septostomy

Lung Transplantation

Pulmonary Thromboendarterectomy

  • Pulmonary thromboendarterectomy (PTE) is a surgical procedure that is used for the treatment of chronic thromboembolic pulmonary hypertension.
  • It is the surgical removal of an organized thrombus along with the lining of the pulmonary artery.
  • PTE is a large and very difficult procedure that is currently performed in a few select centers. Case series show remarkable success in most patients.
  • Treatment for hypoxic and miscellaneous varieties of PH have not been established. However, studies of several agents are currently enrolling patients. Many physicians will treat these diseases with the same medications as for PAH, until better options become available.

References

  1. 1.0 1.1 1.2 1.3 1.4 Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA; et al. (2009). "Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)". Eur Heart J. 30 (20): 2493–537. doi:10.1093/eurheartj/ehp297. PMID 19713419.
  2. Sandoval J, Gaspar J, Pulido T, Bautista E, Martínez-Guerra ML, Zeballos M; et al. (1998). "Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension. A therapeutic alternative for patients nonresponsive to vasodilator treatment". J Am Coll Cardiol. 32 (2): 297–304. PMID 9708453.
  3. Kurzyna M, Dabrowski M, Bielecki D, Fijalkowska A, Pruszczyk P, Opolski G; et al. (2007). "Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension". Chest. 131 (4): 977–83. doi:10.1378/chest.06-1227. PMID 17426198.
  4. Trulock EP, Edwards LB, Taylor DO, Boucek MM, Keck BM, Hertz MI; et al. (2006). "Registry of the International Society for Heart and Lung Transplantation: twenty-third official adult lung and heart-lung transplantation report--2006". J Heart Lung Transplant. 25 (8): 880–92. doi:10.1016/j.healun.2006.06.001. PMID 16890108.

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