Intraoperative management of pulmonary hypertension and associated right heart failure

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.

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).

Knowledge of pulmonary hypertension pathophysiology and treatment modalities will not only improve intraoperative management but also reduce postoperative morbidity and mortality.