Perioperative Management of Pediatric Pulmonary Hypertension

Abstract

Perioperative management of patients with pulmonary hypertension or those at risk for increased pulmonary vascular reactivity should focus on supporting the patient through the vulnerable period of physiologic derangements surrounding surgery, including acute alterations in pulmonary blood flow, altered pulmonary endothelial function following cardiopulmonary bypass, invasive mechanical ventilation, and adaptation to new hemodynamics following correction or palliation of congenital heart disease lesions. These patients require careful attention to each step of perioperative management by teams experienced in the care of pediatric patients with pulmonary hypertension. This article will focus on preoperative evaluation, pulmonary hypertensive crises, general principles of perioperative management, and specific pulmonary vasodilator therapies.