Pulmonary Hypertension Related to Left-Sided Cardiac Pathology

Abstract

Pulmonary hypertension (PH) is the end result of a variety of diverse pathologic processes. The chronic elevation in pulmonary artery pressure often leads to right ventricular pressure overload and subsequent right ventricular failure. In patients with left-sided cardiac disease, PH is quite common and associated with increased morbidity and mortality. This article will review the literature as it pertains to the epidemiology, pathogenesis, and diagnosis of PH related to aortic valve disease, mitral valve disease, left ventricular systolic and diastolic dysfunction, and pulmonary veno-occlusive disease. Moreover, therapeutic strategies, which focus on treating the underlying cardiac pathology will be discussed.

Pulmonary Vascular Hemodynamic Response to Exercise in Cardiopulmonary Diseases

“…Recent studies have established that an exaggerated increment in PAP during exercise is closely associated with impaired functional capacity in HF, 11 PAH, 12,49 exercise-induced PH, 12 and valvular heart disease. 37,62 Additional recent studies have shown that exercise PAP responses potently predict adverse outcomes in HF 11 and valvular heart disease 55,60,62,63 and also predict future PH progression in patients with COPD. 68 However, studies to date have been conducted in relatively small cohorts, using heterogenous exercise protocols, measurement methods, and definitions of abnormal hemodynamic responses to exercise.…”

“…55 The presence of PH at rest or during exercise should therefore be included in perioperative risk assessment of mitral and aortic valve replacement. 56,57 In older patients with severe mitral valve stenosis and PH, the perioperative mortality increases to 20%; therefore, the indication of valve surgery has to be proven carefully.…”

Impact of Body Mass Index >50 on Cardiac Structural and Functional Characteristics and Surgical Outcomes After Bariatric Surgery

“…In our study, despite higher SPAP and increased prevalence of pulmonary hypertension among patients with super obesity, the presence of pulmonary hypertension, interestingly, was not independently associated with LVH. Several studies support the impact of increased weight on the development of breathing disorders and pulmonary hypertension [32]. It is well known that obesity-induced LV hypertrophy can promote LV diastolic dysfunction leading to pulmonary hypertension, but there is increasing evidence that metabolic syndrome, regardless of the presence of obstructive sleep apnea, can alter pulmonary hemodynamics [33].…”

A New Look at Bronchopulmonary Dysplasia: Postcapillary Pathophysiology and Cardiac Dysfunction

“…Of note, patients with PH secondary to mitral valve disease have been excluded from the clinical trials evaluating the current vasodilator therapies. 16 The patho- Note: Except where otherwise noted, data are mean value ± standard deviation. BW: birth weight; GA: gestational age; group 1: preterm infants with bronchopulmonary dysplasia (BPD); group 2: preterm infants with no BPD; group 3: term healthy infants; PDA: patent ductus arteriosus.…”