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Article*
"Development of the European Network in Orphan Cardiovascular Diseases"
„Rozszerzenie Europejskiej Sieci Współpracy ds Sierocych Chorób Kardiologicznych”
Title:Perioperative management of patients with pulmonary arterial hypertension
RCD code: II.1.A
Author: Grzegorz Kopeć
Affiliation: Department of Cardiac and Vascular Diseases, Centre for Rare Cardiovascular
Diseases, John Paul II Hospital, Krakow, Poland
Date:2014.06.09
[* The article should be written in English
John Paul II Hospital in Kraków
Jagiellonian University, Institute of Cardiology
80 Prądnicka Str., 31-202 Kraków;
tel. +48 (12) 614 33 99; 614 34 88; fax. +48 (12) 614 34 88
e-mail: [email protected]
www.crcd.eu
Pulmonary arterial hypertension is a disease of low prevalence, and therefore rarely
seen in surgical practice. The factors that increase the risk of postoperative complications
include right ventricular failure, myocardial ischemia and postoperative hypoxia. In patients
undergoing cardiopulmonary bypass mean pulmonary artery pressure before surgery > 30
mmHg is an independent risk factor of death. The European Society of Cardiology in 2014
issued new recommendations for the diagnosis and treatment of cardiac patients undergoing
non-cardiac surgery. They referred also to patients with pulmonary arterial hypertension.
In patients with pulmonary hypertension undergoing noncardiac surgery complications
are predicted by functional class III or IV, right ventricular dysfunction, prolonged anesthesia
and intermediate or high risk surgery. The incidence of perioperative cardiopulmonary
complications reaches 38% and mortality of 7%. Therefore, if possible, it is advised to avoid
elective surgical interventions. After the diagnosis of pulmonary arterial hypertension has
been made a patient should be transferred to the center of reference in order to start treatment
with drugs specific for pulmonary arterial hypertension. If a decision is made about surgery
pharmacological treatment should be optimized and preparation for surgery should be
discussed by a multidisciplinary team of experts. In the perioperative period the specific
treatment should not be stopped. Sometimes it is necessary to switch the patient to the drugs
used in nebulization or intravenously. Because most complications occur in the early hours
after surgery, it is necessary to closely monitor patients for at least 24 hours after surgery. In
the case of progression of heart failure diuretic treatment should be optimized and, if
necessary, dobutamine infusion started. In refractory cases, it is recommended to include
vasodilators by inhalation or intravenous injection under the supervision of a physician
experienced in the treatment of pulmonary arterial hypertension.
References
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De Hert S, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K,
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PA, Sousa-Uva M, Voudris V, Funck-Brentano C; ESC Committee for Practice Guidelines,
Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C,
John Paul II Hospital in Kraków
Jagiellonian University, Institute of Cardiology
80 Prądnicka Str., 31-202 Kraków;
tel. +48 (12) 614 33 99; 614 34 88; fax. +48 (12) 614 34 88
e-mail: [email protected]
www.crcd.eu
Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart
A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M,
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Robertis E, Longrois D, Langenecker SK, Wichelewski J; Document Reviewers, Piepoli MF,
Wijns W, Agewall S, Ceconi C, Coca A, Corrà U, De Caterina R, Di Mario C, Edvardsen T,
Fagard R, Germano G, Guarracino F, Hoes A, Joergensen T,
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cardiovascular assessment and management of the European Society of Cardiology (ESC) and
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Eur Heart J. 2014 Aug 1. pii: ehu282.
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Author’s signature**
John Paul II Hospital in Kraków
Jagiellonian University, Institute of Cardiology
80 Prądnicka Str., 31-202 Kraków;
tel. +48 (12) 614 33 99; 614 34 88; fax. +48 (12) 614 34 88
e-mail: [email protected]
www.crcd.eu
[** Signing the article will mean an agreement for its publication]
John Paul II Hospital in Kraków
Jagiellonian University, Institute of Cardiology
80 Prądnicka Str., 31-202 Kraków;
tel. +48 (12) 614 33 99; 614 34 88; fax. +48 (12) 614 34 88
e-mail: [email protected]
www.crcd.eu