Key result
Intraoperative management of pulmonary hypertension using pulmonary vasodilators, inotropic agents, and physiological correction can improve management and reduce postoperative morbidity and mortality.
Knowledge of pulmonary hypertension pathophysiology and appropriate intraoperative treatment modalities can improve management and reduce postoperative morbidity and mortality.
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May support optimized intraoperative strategies in pulmonary hypertension; leaves open need for randomized confirmation.
PURPOSE OF REVIEW: Pulmonary hypertension is associated with high perioperative morbidity and mortality. Management of intraoperative pulmonary hypertension, along with frequently associated right heart failure, is extremely challenging. We now review the pathophysiology and clinical management of pulmonary hypertension, and associated right heart failure. RECENT FINDINGS: Pulmonary hypertension results from a combination of both environmental and genetic influences. Current treatments include the use of pulmonary vasodilators, optimization of inotropic agents to support cardiac function, maintenance of perfusion to the right ventricle, and correction of any physiologically detrimental conditions (e.g. hypoxemia, hypercarbia, acidosis, hypothermia, hypervolemia, and increased intrathoracic pressure). SUMMARY: Knowledge of pulmonary hypertension pathophysiology and treatment modalities will not only improve intraoperative management but also reduce postoperative morbidity and mortality.
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Gordon et al. (2009) conducted a review in Pulmonary hypertension and associated right heart failure. Intraoperative management was evaluated. Intraoperative management of pulmonary hypertension using pulmonary vasodilators, inotropic agents, and physiological correction can improve management and reduce postoperative morbidity and mortality.
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