Interventional and Surgical Modalities of Treatment in Pulmonary Hypertension
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...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2009-06, Vol.54 (1), p.S67-S77 |
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| creator | Keogh, Anne M., MBBS, PhD Mayer, Eckhard, MD Benza, Raymond L., MD Corris, Paul, MD Dartevelle, Philippe G., MD Frost, Adaani E., MD Kim, Nick H., MD Lang, Irene M., MD Pepke-Zaba, Joanna, PhD Sandoval, Julio, MD |
| description | 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. |
| doi_str_mv | 10.1016/j.jacc.2009.04.016 |
| format | Article |
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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.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2009.04.016</identifier><identifier>PMID: 19555860</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiology ; Cardiovascular ; Classification ; Colleges & universities ; Confidence intervals ; Endarterectomy ; Heart failure ; Heart Failure - etiology ; Heart-Assist Devices ; Heart-Lung Transplantation ; Hemodynamics ; Humans ; Hypertension, Pulmonary - complications ; Hypertension, Pulmonary - surgery ; Hypertension, Pulmonary - therapy ; Internal Medicine ; interventional modalities ; Life Support Care ; Lung Transplantation ; Medical imaging ; Mortality ; Postoperative period ; Pulmonary arteries ; Pulmonary Artery - surgery ; Pulmonary hypertension ; Risk Assessment ; Surgery ; surgical modalities ; Tomography, X-Ray Computed ; treatment in PAH ; Variables ; Veins & arteries ; Ventilation</subject><ispartof>Journal of the American College of Cardiology, 2009-06, Vol.54 (1), p.S67-S77</ispartof><rights>American College of Cardiology Foundation</rights><rights>2009 American College of Cardiology Foundation</rights><rights>Copyright Elsevier Limited Jun 30, 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c545t-32f4bd4d9349333805136351121aebf57bfd1232753b54d2e0c856dbf2d4aa6d3</citedby><cites>FETCH-LOGICAL-c545t-32f4bd4d9349333805136351121aebf57bfd1232753b54d2e0c856dbf2d4aa6d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109709012212$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19555860$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keogh, Anne M., MBBS, PhD</creatorcontrib><creatorcontrib>Mayer, Eckhard, MD</creatorcontrib><creatorcontrib>Benza, Raymond L., MD</creatorcontrib><creatorcontrib>Corris, Paul, MD</creatorcontrib><creatorcontrib>Dartevelle, Philippe G., MD</creatorcontrib><creatorcontrib>Frost, Adaani E., MD</creatorcontrib><creatorcontrib>Kim, Nick H., MD</creatorcontrib><creatorcontrib>Lang, Irene M., MD</creatorcontrib><creatorcontrib>Pepke-Zaba, Joanna, PhD</creatorcontrib><creatorcontrib>Sandoval, Julio, MD</creatorcontrib><title>Interventional and Surgical Modalities of Treatment in Pulmonary Hypertension</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>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. 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Mayer, Eckhard, MD ; Benza, Raymond L., MD ; Corris, Paul, MD ; Dartevelle, Philippe G., MD ; Frost, Adaani E., MD ; Kim, Nick H., MD ; Lang, Irene M., MD ; Pepke-Zaba, Joanna, PhD ; Sandoval, Julio, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c545t-32f4bd4d9349333805136351121aebf57bfd1232753b54d2e0c856dbf2d4aa6d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Classification</topic><topic>Colleges & universities</topic><topic>Confidence intervals</topic><topic>Endarterectomy</topic><topic>Heart failure</topic><topic>Heart Failure - etiology</topic><topic>Heart-Assist Devices</topic><topic>Heart-Lung Transplantation</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - complications</topic><topic>Hypertension, Pulmonary - surgery</topic><topic>Hypertension, Pulmonary - therapy</topic><topic>Internal Medicine</topic><topic>interventional modalities</topic><topic>Life Support Care</topic><topic>Lung Transplantation</topic><topic>Medical imaging</topic><topic>Mortality</topic><topic>Postoperative period</topic><topic>Pulmonary arteries</topic><topic>Pulmonary Artery - surgery</topic><topic>Pulmonary hypertension</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>surgical modalities</topic><topic>Tomography, X-Ray Computed</topic><topic>treatment in PAH</topic><topic>Variables</topic><topic>Veins & arteries</topic><topic>Ventilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keogh, Anne M., MBBS, PhD</creatorcontrib><creatorcontrib>Mayer, Eckhard, MD</creatorcontrib><creatorcontrib>Benza, Raymond L., MD</creatorcontrib><creatorcontrib>Corris, Paul, MD</creatorcontrib><creatorcontrib>Dartevelle, Philippe G., MD</creatorcontrib><creatorcontrib>Frost, Adaani E., MD</creatorcontrib><creatorcontrib>Kim, Nick H., MD</creatorcontrib><creatorcontrib>Lang, Irene M., MD</creatorcontrib><creatorcontrib>Pepke-Zaba, Joanna, PhD</creatorcontrib><creatorcontrib>Sandoval, Julio, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keogh, Anne M., MBBS, PhD</au><au>Mayer, Eckhard, MD</au><au>Benza, Raymond L., MD</au><au>Corris, Paul, MD</au><au>Dartevelle, Philippe G., MD</au><au>Frost, Adaani E., MD</au><au>Kim, Nick H., MD</au><au>Lang, Irene M., MD</au><au>Pepke-Zaba, Joanna, PhD</au><au>Sandoval, Julio, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interventional and Surgical Modalities of Treatment in Pulmonary Hypertension</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2009-06-30</date><risdate>2009</risdate><volume>54</volume><issue>1</issue><spage>S67</spage><epage>S77</epage><pages>S67-S77</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Most patients with chronic thromboembolic pulmonary hypertension are operable, and pulmonary endarterectomy is the treatment of choice. 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| subjects | Cardiology Cardiovascular Classification Colleges & universities Confidence intervals Endarterectomy Heart failure Heart Failure - etiology Heart-Assist Devices Heart-Lung Transplantation Hemodynamics Humans Hypertension, Pulmonary - complications Hypertension, Pulmonary - surgery Hypertension, Pulmonary - therapy Internal Medicine interventional modalities Life Support Care Lung Transplantation Medical imaging Mortality Postoperative period Pulmonary arteries Pulmonary Artery - surgery Pulmonary hypertension Risk Assessment Surgery surgical modalities Tomography, X-Ray Computed treatment in PAH Variables Veins & arteries Ventilation |
| title | Interventional and Surgical Modalities of Treatment in Pulmonary Hypertension |
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