Preoperative Risk Assessment of Pulmonary Arterial Hypertension Patients Undergoing General Surgery

Abstract

Pulmonary arterial hypertension (PAH) is a disease of the pulmonary vasculature that is characterized by a progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) resulting in the development of right ventricular (RV) failure, inadequate oxygenation, and ultimately death. Anesthesia and surgery, both cardiac and noncardiac, are associated with significantly increased morbidity and mortality in patients with PAH due mainly to RV failure, arrhythmias, postoperative hypoxemia, and myocardial ischemia. Preoperative risk assessment and successful management of patients with PAH undergoing general surgery involves an understanding of the pathophysiology of the disease, analysis of preoperative and operative risk factors, intraoperative management, and early recognition and treatment of postoperative complications.