Rev Mal Respir. 2011 Feb;28(2):139-51.

[Surgical treatment of pulmonary arterial hypertension].[Article in French]

Fadel E, Mercier O, Mussot S, Fabre D, Humbert M, Simonneau G, Dartevelle P.

Service de chirurgie thoracique, vasculaire et transplantation cardiopulmonaire, Centre chirurgical Marie-Lannelongue, 133 avenue de la Résistance, Le Plessis Robinson, France.

Abstract

INTRODUCTION: Pulmonary arterial hypertension (PAH) is a severe disease that has undergone a dramatic improvement in therapeutic management over the past 20 years. Among the new therapeutic options, surgery has the potential to dramatically improve or, in some cases, cure PAH.

BACKGROUND: Surgical treatment of PAH includes pulmonary endarterectomy which can cure PAH when the cause is obstruction of the pulmonary arteries by fibrous tissue resulting from pulmonary embolism, by tumours as angiosarcomas, and echinococcus cysts. Transplantation is required in end-stage PAH after failure of medical treatment. Atrial septostomy and Potts procedure are palliative surgical procedures that can delay transplantation.

VIEWPOINT: Extracorporeal cardiopulmonary support is the latest surgical improvement, not only as a bridge to transplantation in end-stage PAH but also during recovery after transplantation or pulmonary endarterectomy.

CONCLUSIONS: Surgery is part of the therapeutic management of PAH. Dialogue between physicians and surgeons is a prerequisite for any reasoned therapeutic decision.

PMID: 21402229