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Review
. 2014 Mar;4(1):10-24.
doi: 10.1086/674885.

Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery

Nathan Brunner  1 , Vinicio A de Jesus Perez  1 , Alice Richter  1 , François Haddad  2 , André Denault  3 , Vanessa Rojas  1 , Ke Yuan  1 , Mark Orcholski  1 , Xiaobo Liao  4
Affiliations
Review

Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery

Nathan Brunner et al. Pulm Circ. 2014 Mar.

Abstract

Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.

Keywords: congenital heart diseases; perioperative pharmacological therapies; pulmonary arterial hypertension; pulmonary hypertensive crisis.

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Figures

Figure 1
Figure 1
Three therapeutic pathways. iNO: inhaled nitric oxide; PDE: phosphodiesterase; PDEI: PDE inhibitor; cGMP: cyclic guanosine monophosphate; PVSMC: pulmonary vascular smooth muscle cell.
Figure 2
Figure 2
Recommended algorithm for perioperative management of patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) in the setting of cardiac surgery. PVD: pulmonary vascular disease; RHF: right heart failure; IV: intravenous; iNO: inhaled nitric oxide; ECMO: extracorporeal membrane oxygenation; HTx: heart transplantation; LTx: lung transplantation.
See this image and copyright information in PMC

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