Interventional and surgical modalities of treatment in pulmonary hypertension

J Am Coll Cardiol. 2009 Jun 30;54(1 Suppl):S67-77. doi: 10.1016/j.jacc.2009.04.016.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Endarterectomy*
  • Heart Failure / etiology
  • Heart-Assist Devices
  • Heart-Lung Transplantation
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / complications
  • Hypertension, Pulmonary / surgery
  • Hypertension, Pulmonary / therapy*
  • Life Support Care
  • Lung Transplantation
  • Pulmonary Artery / surgery*
  • Risk Assessment
  • Tomography, X-Ray Computed