Portopulmonary hypertension
ICD-10 K76.9 · ICD-11 DB99.3

Treatment of Portopulmonary Hypertension in WHO Functional Class II or III

Clinical Scenario

This protocol applies to patients with portopulmonary hypertension presenting in WHO functional class II or III — a population in whom targeted pharmacological intervention is indicated to reduce pulmonary vascular burden and improve functional capacity.

Specific Population

Endothelin receptor antagonists are targeted for patients with a functional class of II and III, whether as monotherapy or in conjunction with other agents. The functional class directly informs agent selection in this setting.

Treatment Approach (Partial)

Management centres on endothelin receptor antagonist monotherapy as the primary approach. Supportive measures addressing oxygen saturation and volume overload are given alongside the primary treatment. The complete agent selection, dosing sequence, and stepwise algorithm are available through the full regimen.

Treatment Goals

Reduction of mean pulmonary arterial pressure and pulmonary vascular resistance, with improved exercise tolerance measured by the 6-minute walking test. Response is evaluated at 3-month follow-up right heart catheterisation.

Instant Access to Structured Evidence-Based Regimens

References

  1. The endothelin receptor antagonists are targeted for patients with a functional class of II and III, whether as monotherapy or in conjunction with phosphodiesterase inhibitors as a combined therapy.
  2. Supplementary oxygen is recommended for patients with oxygen saturation <89%, as per ILTS guidelines.
  3. Diuretics, which are frequently used for the treatment of portal hypertension, are important in the management of PH and volume overload.
  4. Bosentan has demonstrated its efficacy with an improvement of the functional class (6-min walking test) and pulmonary hemodynamics.
DOI: 10.1097/TXD.0000000000001517
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