Providing effective care of patients with pulmonary hypertension requires a thorough understanding of the etiology and severity of the disease. Persons with pulmonary hypertension can experience a range of symptoms, from shortness of breath, chest pains, fatigue, to syncope. These effects on the body stem from increased right heart strain and eventually right heart failure in advanced disease. Pulmonary hypertension is divisible into five groups with different mechanisms. Differentiation of pulmonary hypertension by group has important implications in the treatment of the disease for a specific patient, although some principles of management are applicable for all types. Important considerations to keep in mind for preoperative, intraoperative, and postoperative care of patients with pulmonary hypertension are also discussed.

The intra-aortic balloon pump (IABP) is the most common and readily available form of mechanical support for a failing heart. IABPs decrease myocardial oxygen consumption while increasing the oxygen supply to the myocardium, improving the oxygen supply/demand balance by a mechanism called counterpulsation. The IABP synchronizes with the heartbeat to inflate during diastole and deflate during systole. Increased diastolic pressure improves coronary perfusion, and systolic unloading decreases the oxygen consumption of the left ventricle. General indications for IABP placement are based on the beneficial physiological effects of the device. Complications arise from the process of placing the device or vascular injury associated with the prolonged use of IABPs.

No abstract