Management of peri-operative pulmonary hypertension in a patient presenting for a portosystemic shunt

We report the successful management of intra- operative pulmonary hypertens ion in a patient with mitral valve insufficiency and portal hypertension. A 48-year-old male with portal hypertension presented for a portosystemic sh unt. Previously undiagnosed mitral valve insufficiency and pulmonary hypert ension complicated his anaesthetic management. His intra- operative course was marked by systolic hypotension, pulmonary hypertension and a reduction in cardiac output. The use of nitric oxide in this patient reduced right ve ntricular afterload, increased cardiac output, without exacerbating pre-exi sting systolic hypotension.