Preface

Chapter 9 **Perioperative Considerations of Patients with Pulmonary**

Henry Liu, Philip L. Kalarickal, Yiru Tong, Daisuke Inui, Michael J. Yarborough, Kavitha A. Mathew, Amanda Gelineau, Alan D. Kaye

**Hypertension 195**

and Charles Fox

**VI** Contents

When Viktorija Zgela, Senior Commissioning Editor, InTech, approached us in the spring of 2012 to assist with editing a book about pulmonary hypertension that was already under‐ way, little did we know what we were getting into. The work was already in progress with authors assigned to topics, research and writing started. Indeed, we stepped into fast mov‐ ing process that had long passed the conceptual stage and was well into realization. We greatly thank Ms. Zgela and her colleagues at InTech for their patience and assistance guid‐ ing us through the process to bring this work to publication. Without their assistance, this book would never have made it to the presses.

We are greatly indebted to all the chapter authors who have persevered through multiple revisions, delays, and countless nights and weekends revising and editing. This final work reveals the fruit of all their labor.

In the initial chapter, **Pulmonary Arterial Hypertension: An Overview**, Saleem Sharieff presents a comprehensive synopsis of the epidemiologic, clinical, histopathologic, and thera‐ py of PAH. Next, Dimitar Sajkov, Bliegh Mupunga, Jeffrey J. Bowden, and Nikolai Petrov‐ sky comprehensively review World Health Organization group III PH in **Pulmonary Hypertension in Chronic Lung Diseases and/or Hypoxia**. The focus then shifts to the cellu‐ lar and biochemical derangements underlying the pathophysiology of PH which are sum‐ marized by Rajamma Mathew in the **Pathogenesis of Pulmonary Hypertension**. Specific mechanisms that have been implicated in the pathogenesis of PH are presented by Junko Maruyama, Ayumu Yokochi, Erquan Zhang, Hirohumi Sawada, Kazuo Maruyama in **Nitric Oxide in the Pathophysiology and Treatment of Pulmonary Hypertension**, and Aureliano Hernández and Rafael A. Areiza in **Angiogenesis and Pulmonary Hypertension**. The focus then shifts to PH associated with thromboembolic disease. We discuss PH that occurs in as‐ sociation with acute thromboembolism in **Acute Thromboembolic Pulmonary Hyperten‐ sion**. Mehdi Badidi and M'Barek Nazi present a comprehensive overview of PH caused by chronic thromboembolic disease in **Chronic Thromboembolic Pulmonary Hypertension**. Juan C.Grignola, María J. Ruiz-Cano, Juan P. Salisbury, Gabriela Pascal, Pablo Curbelo, and Pilar Escribano present a detailed overview of the physiologic assessment of patients with chronic thromboembolic disease prior to surgical pulmonary endarterectomy in **Assessment of Diagnostic Testing to Guide the Surgical Management of Chronic Thromboembolic Pulmonary Hypertension**. Finally, Henry Liu, Philip L. Kalarickal, Yiru Tong, Daisuke Inui, Michael J Yarborough, Kavitha A. Mathew, Amanda Gelineau, and Charles Fox comprehen‐ sively review the clinical perioperative evaluation and management of patients with PH in **Perioperative Considerations of Patients with Pulmonary Hypertension.**

We thank all the editors at InTech and all the authors for their diligence and effort in pro‐ ducing and writing this text. Most importantly, we thank our spouses for their lenience and sympathetic tolerance of the long weekends and late nights writing, editing, reading, and revising this work to bring it to publication.

> **Jean M. Elwing Ralph J. Panos**

**Chapter 1**

**Pulmonary Arterial Hypertension: An Overview**

Pulmonary hypertension (PH) is a hemodynamic state defined by a resting mean pulmonary artery pressure (PAP) at or above 25 mm Hg.[1] with normal left ventricular filling pressure

Pre-capillary PH is defined as mean PAP ≥25 mm Hg in association with PAOP ≤15 mm Hg and a pulmonary vascular resistance (PVR) >3 Wood units. This include group 1, 3, 4 and 5 (Table 1). [2] Post-capillary PH (group 2 as shown in Table 1) is characterized by a mean PAP ≥25 mm Hg in association with PAOP >15 mm Hg and PVR ≤3 Wood units.[3] This differen‐ tiation in pre- and post-capillary PH is important as it narrows the differential diagnosis and

> © 2013 Sharieff MBBS, FCPS, FRCPC; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Sharieff MBBS, FCPS, FRCPC; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Additional information is available at the end of the chapter

(mean pulmonary wedge pressure) 15 mmHg or less.

1.2.2. ALK1, endoglin (with or without hereditary hemorrhagic telangiectasia)

Saleem Sharieff

**1. Introduction**

http://dx.doi.org/10.5772/56055

also has treatment implications.

1. Pulmonary arterial hypertension (PAH)

1.1. Idiopathic PAH 1.2. Heritable 1.2.1. BMPR2

1.2.3. Unknown

1.4.2. HIV infection 1.4.3. Portal hypertension 1.4.4. Congenital heart diseases

1.4.5. Schistosomiasis

1.3. Drug- and toxin-induced 1.4. Associated with

1.4.1. Connective tissue diseases

1.4.6. Chronic hemolytic anemia
