Management of Severe Pulmonary Arterial Hypertension

被引：24

作者：

Granton, John ^{[1
,2
,3
]}

Mercier, Olaf ^{[4
]}

De Perrot, Marc ^{[3
,5
]}

机构：

[1] Univ Toronto, Mt Sinai Hosp, Univ Hlth Network, Div Respirol, Toronto, ON M5G 1X5, Canada

[2] Univ Toronto, Mt Sinai Hosp, Univ Hlth Network, Interdept Div Crit Care, Toronto, ON M5G 1X5, Canada

[3] Univ Toronto, Toronto Gen Hosp, Lung Transplant Program, Toronto, ON M5G 1L7, Canada

[4] Univ Paris Sud, Hop Marie Lannelongue, Dept Thorac & Vasc Surg & Heart Lung Transplantat, Paris, France

[5] Univ Toronto, Dept Surg, Univ Hlth Network, Div Thorac Surg, Toronto, ON, Canada

来源：

SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE | 2013年 / 34卷 / 05期

关键词：

pulmonary hypertension; right ventricular failure; intensive care; extracorporeal life support; lung transplantation; EXTRACORPOREAL MEMBRANE-OXYGENATION; RIGHT-VENTRICULAR HYPERTROPHY; RIGHT HEART-FAILURE; INTENSIVE-CARE-UNIT; LUNG-TRANSPLANTATION; ATRIAL SEPTOSTOMY; PRESSURE-OVERLOAD; INTERNATIONAL-SOCIETY; SWITCH OPERATION; CARDIAC-OUTPUT;

D O I：

10.1055/s-0033-1356460

中图分类号：

R4 [临床医学];

学科分类号：

100218 [急诊医学];

摘要：

Despite advances in medical therapies, pulmonary arterial hypertension (PAH), continues to cause significant morbidity and mortality. Although, the right ventricle can adapt to an increase in afterload, progression of the pulmonary vasculopathy that characterizes PAH causes many patients to develop progressive right ventricular (RV) failure. Furthermore, acute RV decompensation may develop from disorders that lead to either an acute increase in cardiac demand or an increase in ventricular afterload including interruptions in medical therapy, arrhythmia, or pulmonary embolism. The poor reserve of the right ventricle, RV ischemia, and adverse RV influence on left ventricular filling may lead to a global reduction in oxygen delivery and multiorgan failure. The authors present an approach to patients with advanced PAH focusing on both medical and surgical strategies to improve RV function based upon current evidence and physiological principles.

引用

页码：700 / 713

页数：14

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