Interventional and Surgical Modalities of Treatment in Pulmonary Hypertension

Anne M. Keogh, Eckhard Mayer, Raymond L. Benza, Paul Corris, Philippe G. Dartevelle, Adaani E. Frost, Nick H. Kim, Irene M. Lang, Joanna Pepke-Zaba, Julio Sandoval

Research output: Contribution to journalReview article

185 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)S67-S77
JournalJournal of the American College of Cardiology
Volume54
Issue number1 SUPPL. 1
DOIs
StatePublished - Jun 30 2009

Keywords

  • interventional modalities
  • surgical modalities
  • treatment in PAH

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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