Pulmonary hypertension related to left-sided cardiac pathology

Abstract

Pulmonary hypertension (PH) is the end result of a variety of diverse pathologic processes. The chronic elevation in pulmonary artery pressure often leads to right ventricular pressure overload and subsequent right ventricular failure. In patients with left-sided cardiac disease, PH is quite common and associated with increased morbidity and mortality. This article will review the literature as it pertains to the epidemiology, pathogenesis, and diagnosis of PH related to aortic valve disease, mitral valve disease, left ventricular systolic and diastolic dysfunction, and pulmonary veno-occlusive disease. Moreover, therapeutic strategies, which focus on treating the underlying cardiac pathology will be discussed.

Figure 1

Anatomic organization of left heart causes of pulmonary hypertension from the right ventricle through the lungs to the left ventricular outflow tract.

Figure 2

Pulmonary vein wedge angiography. In panel (a) balloon occlusion with hand contrast injection demonstrates opacification of the distal branches of the right upper pulmonary artery (RUPA) and in panel (b) the levophase of the wedge angiogram shows normal right upper pulmonary vein (RUPV) drainage into the left atrium (LA). Panel (c) shows normal opacification of the distal branches of the left lower pulmonary artery (LLPA) with wedge angiography. However, during the levophase in panel (d), there is abnormal drainage of the left lower pulmonary vein (LLPV) with contrast persisting in the LLPA and the absence of contrast media in the LA diagnostic of PVOD.