Differentiating Pulmonary Arterial and Pulmonary Venous Hypertension and the Implications for Therapy

Dadfarmay, Sina; Berkowitz, Robert; Kim, Bernard; Manchikalapudi, Rama Bindu

doi:10.1111/j.1751-7133.2010.00192.x

Cited by 27 publications

(19 citation statements)

References 9 publications

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“…PH due to left heart disease is the most common cause of PH [1]. It affects primarily the pulmonary venous bed [2] and is therefore also called pulmonary venous hypertension (PVH) or postcapillary PH [3]. This aspect plays a pivotal role in the therapy of PVH, as vasodilators that act predominantly in the pulmonary arterial bed may increase the pulmonary perfusion and thereby enhance hydrostatic pressure, pulmonary edema and total pulmonary vascular resistance (PVR) [1].…”

Section: Introductionmentioning

confidence: 99%

Milrinone Relaxes Pulmonary Veins in Guinea Pigs and Humans

Rieg

Suleiman²,

Pérez-Bouza

et al. 2014

PLoS ONE

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IntroductionThe phosphodiesterase-III inhibitor milrinone improves ventricular contractility, relaxes pulmonary arteries and reduces right ventricular afterload. Thus, it is used to treat heart failure and pulmonary hypertension (PH). However, its action on pulmonary veins (PVs) is not defined, although particularly PH due to left heart disease primarily affects the pulmonary venous bed. We examined milrinone-induced relaxation in PVs from guinea pigs (GPs) and humans.Material and MethodsPrecision-cut lung slices (PCLS) were prepared from GPs or from patients undergoing lobectomy. Milrinone-induced relaxation was studied by videomicroscopy in naïve PVs and in PVs pre-constricted with the ETA-receptor agonist BP0104. Baseline luminal area was defined as 100%. Intracellular cAMP was measured by ELISA and milrinone-induced changes of segmental vascular resistances were studied in the GP isolated perfused lung (IPL).ResultsIn the IPL (GP), milrinone (10 µM) lowered the postcapillary resistance of pre-constricted vessels. In PCLS (GP), milrinone relaxed naïve and pre-constricted PVs (120%) and this relaxation was attenuated by inhibition of protein kinase G (KT 5823), adenyl cyclase (SQ 22536) and protein kinase A (KT 5720), but not by inhibition of NO-synthesis (L-NAME). In addition, milrinone-induced relaxation was dependent on the activation of KATP-, BKCa 2+- and Kv-channels. Human PVs also relaxed to milrinone (121%), however only if pre-constricted.DiscussionMilrinone relaxes PVs from GPs and humans. In GPs, milrinone-induced relaxation is based on KATP-, BKCa 2+- and Kv-channel-activation and on cAMP/PKA/PKG. The relaxant properties of milrinone on PVs lead to reduced postcapillary resistance and hydrostatic pressures. Hence they alleviate pulmonary edema and suggest beneficial effects of milrinone in PH due to left heart disease.

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Section: Introductionmentioning

confidence: 99%

Milrinone Relaxes Pulmonary Veins in Guinea Pigs and Humans

Rieg

Suleiman²,

Pérez-Bouza

et al. 2014

PLoS ONE

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“…4 Shortness of breath is the most frequently symptoms of pulmonary hypertension. 5 In the present study, the authors indicated the recovery in pulmonary function tests by bronchodilator therapy but it was not correlated with the improvement in Borg dyspnea measurements. Undiagnosed or untreated pulmonary hypertension may cause the reason of this result.…”

mentioning

confidence: 56%

Heart failure: Not only reduced left ventricular ejection fraction but also reserved ejection fraction!

et al. 2013

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“…Patients with diastolic HF are at an increased risk of developing irreversible PH (precapillary PH) [ 46 ]. Whereas passive postcapillary PH frequently is reversible and likely to improve, the vascular remodeling of precapillary PH may not regress after surgical and medical treatment of the underlying cardiac disease [ 46 ]. PH commonly is diagnosed by TTE or by invasive rightheart catheterization, and is a marker of poor prognosis in patients with HF [ 47 ].…”

Section: Preoperative Assessmentmentioning

confidence: 99%

“…Therefore some patients develop elevated TPG (>10 mmHg) and pulmonary vascular resistance (PVR >2.5-3 Wood units), and these changes in TPG and PVR indicate the development of irreversible precapillary PH [ 44 , 46 ]. Patients with diastolic HF are at an increased risk of developing irreversible PH (precapillary PH) [ 46 ]. Whereas passive postcapillary PH frequently is reversible and likely to improve, the vascular remodeling of precapillary PH may not regress after surgical and medical treatment of the underlying cardiac disease [ 46 ].…”

Section: Preoperative Assessmentmentioning

confidence: 99%

Perioperative Anesthesia Management in Secondary Mitral Regurgitation and Heart Failure

Conte

2014

Secondary Mitral Valve Regurgitation

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This chapter provides an overview of the anesthesia and perioperative intensive care management of patients undergoing surgery for secondary mitral regurgitation (SMR).Evidence-based medicine has led to an unprecedented growth in the scientifi c approach to decision making in the belief that it will translate into benefi ts for patients to decrease their risk and improve outcomes (Cheng and Martin, Semin Cardiothoracic Vasc Anesth 9:1-4, 2005). However, clinicians must apply innumerable, complex, and dynamic interventions to the perioperative care of these challenging patients, interventions that are adjusted to achieve a number of physiologic and clinical goals by selecting, titrating, and timely applying many pharmacologic and nonpharmacologic therapies. In doing so clinicians are of course driven by the available evidence, but also by inductive pathophysiologic reasoning, local culture and policies, resource and technology availability, various concerns, beliefs, bias, and random events. While it is clear that outcome of major surgery is affected greatly by surgical prowess and volume (Birkmeyer et al., N Engl J Med 349:2117-2127, in addition, part of the variance in surgical mortality relates to factors beyond surgical skills, namely to all of that complex activity that is the perioperative medicine (Grocott and Pearse Br J Anaesth 108:723-726, 2012). Therefore, albeit only a few nonsurgical interventions have randomized evidence to support their effect in reducing mortality in patients undergoing cardiac surgery (CS) (Landoni et al., Acta Anaesthesiol Scand 5:259-266, 2011), it is believed that perioperative medicine matters.Perioperative management of patients with SMR is accordingly outlined in the text hereafter, with a main focus on hemodynamics along with hints stemming from an integrative approach of the heart interacting with other organ systems. An extensive review of the body of knowledge relevant to the cardiac anesthesiologist and of all the challenges and details of anesthesia and perioperative management in cardiac surgical candidates is beyond the scope of this chapter and can be found in reference cardiac anesthesia and CS texts. Preoperative and intraoperative echocardiographic imaging, as well as minimally invasive mitral valve (MV) surgery and percutaneous Mitra Clip procedures are covered elsewhere in this book

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Differentiating Pulmonary Arterial and Pulmonary Venous Hypertension and the Implications for Therapy

Cited by 27 publications

References 9 publications

Milrinone Relaxes Pulmonary Veins in Guinea Pigs and Humans

Milrinone Relaxes Pulmonary Veins in Guinea Pigs and Humans

Heart failure: Not only reduced left ventricular ejection fraction but also reserved ejection fraction!

Perioperative Anesthesia Management in Secondary Mitral Regurgitation and Heart Failure

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