Treatment of Pulmonary Hypertension Secondary to Left Heart Disease in Aortic Stenosis
Pulmonary hypertension (PH) developing in the context of left heart disease requires identifying and addressing the structural driver of elevated pressures. In patients with aortic stenosis, valvular obstruction contributes directly to the haemodynamic burden on the pulmonary circulation.
This protocol addresses patients with pulmonary hypertension secondary to left heart disease in the setting of aortic stenosis. Pre-interventional PH in this population is associated with a higher risk of in-hospital adverse events and adverse long-term outcomes following valve intervention.
The primary haemodynamic objectives are reduction in pulmonary arterial wedge pressure and pulmonary arterial pressure, together with improvement in forward stroke volume.
Management is directed at the underlying valve pathology, with the intervention being either surgical or catheter-based in nature. The complete evidence-based regimen — including procedural selection, haemodynamic targets, and post-intervention monitoring — is detailed in the full protocol.
References
DOI: 10.1093/eurheartj/ehac237
In patients with aortic stenosis undergoing surgical or catheter-based aortic valve repair, pre-interventional PH is associated with a higher risk of in-hospital adverse events and adverse long-term outcomes.
While surgical or interventional approaches for valvular repair improve cardiopulmonary haemodynamics by reducing PAWP and PAP and improving forward SV, persistent PH after correcting valvular heart disease is frequent and associated with adverse outcomes.
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