MEDICAL AND SURGICAL-TREATMENT OPTIONS FOR PULMONARY-HYPERTENSION

Significant advances in the treatment of pulmonary hypertension have b een achieved in the past decade, Approximately one quarter of patients with primary pulmonary hypertension (PPH) can be effectively managed with chronic calcium channel blocker therapy; for the remainder, trans plantation or continuous intravenous epoprostenol are complex but effe ctive approaches, Epoprostenol therapy was initially envisioned as a b ridge to transplantation, but recent experience has established this a pproach as an alternative to transplantation in some patients, with co mparable survival rates, Not all patients derive benefit from epoprost enol, however, and adverse effects are common, Accordingly, patients w ho fall into New York Heart Association Functional Classes III and IV and who are refractory to oral vasodilator therapy should be evaluated both for the initiation of epoprostenol therapy and concurrent listin g for transplantation. By delaying or avoiding transplantation through the use of epoprostenol, these patients may also benefit from ongoing research that targets novel therapeutic approaches and less cumbersom e delivery mechanisms, Thus, epoprostenol may serve as a bridge to tra nsplantation for some patients and to newer therapeutic options for ot hers.