Newly Published
Clinical Focus Review  |   May 2019
Inflammatory Basis of Pulmonary Arterial Hypertension: Implications for Perioperative and Critical Care Medicine
Author Notes
  • From the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (N.M.G., B.E.S.); Sick Kids Research Institute, Program in Cell Biology (N.M.G.) and Program in Neuroscience and Mental Health (B.E.S.), Toronto, Ontario, Canada; Department of Pediatrics and Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, California (M.R.).
  • Submitted for publication October 24, 2018. Accepted for publication March 18, 2019.
    Submitted for publication October 24, 2018. Accepted for publication March 18, 2019.×
  • Correspondence: Address correspondence to Dr. Steinberg: Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. benjamin.steinberg@sickkids.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care / Respiratory System / Clinical Focus Review
Clinical Focus Review   |   May 2019
Inflammatory Basis of Pulmonary Arterial Hypertension: Implications for Perioperative and Critical Care Medicine
Anesthesiology Newly Published on May 6, 2019. doi:10.1097/ALN.0000000000002740
Anesthesiology Newly Published on May 6, 2019. doi:10.1097/ALN.0000000000002740
Pulmonary hypertension, defined as a resting mean pulmonary artery pressure greater than or equal to 25 mmHg, results from a myriad of conditions. The Fifth World Symposium on Pulmonary Hypertension proposed a classification system that organizes pulmonary hypertension into five groups based on common hemodynamic, pathophysiologic, and therapeutic parameters.1  This review focuses on pulmonary arterial hypertension (Group 1 pulmonary hypertension), a disease in which progressive pulmonary vascular obstruction, remodeling, and destruction lead to increased right ventricular afterload and hypertrophy, right heart failure, and death. On a cellular level, the dysregulated proliferation of endothelial, smooth muscle, and immune cells predominates within the diseased vessels.2  Hemodynamically, pulmonary arterial hypertension can be defined as a mean pulmonary artery pressure greater than 25 mmHg, a pulmonary capillary wedge pressure less than 15 mmHg, and a pulmonary vascular resistance (PVR) greater than 3 Wood units in the absence of a more common cause such as left heart disease, chronic venothromboembolic disease, or lung disease. Like pulmonary hypertension in general, pulmonary arterial hypertension can result from multiple causes, including infectious and autoimmune pathologies. In this review, our focus will be on pulmonary arterial hypertension specifically (World Health Organization Group 1), predominantly comprising idiopathic and heritable pulmonary arterial hypertension, as well as pulmonary arterial hypertension associated with connective tissue disease, congenital heart disease, or other systemic conditions.