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INTRODUCTION

Pulmonary hypertension (PH) is a state of abnormally elevated blood pressure within the pulmonary arteries, formally defined as a mean pulmonary artery pressure (mPAP) ≥25 mmHg measured via right heart catheterization.1 PH is grouped based on pathophysiology (Table 17-1). Pulmonary arterial hypertension (PAH; group 1) is associated with the greatest risk of morbidity and mortality and usually requires direct treatment (Table 17-2). Other forms of PH are still significant but are more secondary to other conditions requiring optimization, including oxygen therapy, diuresis, and anticoagulation.2

TABLE 17-1Pulmonary Hypertension (PH) Classification Based on Pathophysiology1
TABLE 17-2Pharmacotherapy Specific for Pulmonary Hypertension (PH)

Increasing use of echocardiography and heightened awareness of PH have increased the overall incidence of the disease, including in surgical patients. Although the long-term concerns related to mild PH may not be great, the perioperative consequences of any type or severity of PH are significant. Patients with PH have reduced capacity to accommodate the sudden alterations in pulmonary pressures and right ventricular (RV) preload and afterload induced by several perioperative factors (Table 17-3).3 Recent data show decreases in PH-associated perioperative complications, but morbidity remains 6–42% and mortality 4–26%.4

TABLE 17-3Perioperative Factors which May Exacerbate Pulmonary Hypertension2

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