Pulmonary embolism and pulmonary hypertension
Summary
The primary focus of interventional cardiology is the coronary circulation and, recently, the aortic and mitral valves. Contemporary “adult interventionists” have paid little attention to the right heart and to the pulmonary vessels. In contrast to the systemic circulation, the pulmonary circulation is a high-flow low-resistance system. To preserve cardiac output, the right ventricle responds to an increase in resistance by augmenting right ventricular pressure. Pulmonary embolism (PE), one of the more common conditions increasing RV afterload, is a cardiovascular emergency. Depending on the clinical presentation, initial therapy is primarily aimed at life-saving restoration of flow through occluded pulmonary arteries, or at the prevention of early recurrences. Failure to resolve acute pulmonary thromboemboli is a potential explanation for chronic thromboembolic pulmonary hypertension (CTEPH). This condition appears to be one of the more common subsets of pulmonary hypertension (PH). “The end is where we start from” refers to the extensive loss of functional pulmonary vessels which has already taken place in >80% of patients with pulmonary arterial hypertension (PAH) at the point when clinical symptoms of PH occur for the first time. According to the current guidelines for the diagnosis and treatment of PH, the diagnostic classification separates pre- from...
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