Pulmonary hypertension presents a great challenge to the anesthesiologist. The number of patients suffering from pulmonary hypertension presenting for surgery is increasing because of increased age and the modern medical and surgical therapy as well. We present a case of a patient suffering from pulmonary hypertension scheduled for left radical nephrectomy due to left kidney tumor. Preoperative optimization and prevention of deterioration of pulmonary hypertension and right side heart failure are the problems the anesthesiologist must deal with. A good collaboration among cardiologist, anesthesiologist, and the surgeon can guarantee the patient's outcome.
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