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Pulmonary Arterial Hypertension

  • Shinji KatsuragiEmail author
  • Tomoaki Ikeda
Chapter

Abstract

Pulmonary arterial hypertension (PAH) is a complex disorder in which pulmonary artery (PA) obstruction leads to elevated PA resistance and right ventricular (RV) failure. Elevation of the pulmonary arterial blood pressure (PABP) is correlated with progressive damage to the pulmonary artery. Before development of surgery for ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA), most patients died around the age 40, with right-sided cardiac failure being the main cause of death. Deterioration in pregnancy is reported to occur in the second or third trimester and in the postpartum period. Sudden hemodynamic instability is a common cause of death. The risk of cardiac failure during and after pregnancy increases, and sudden cardiac arrest may occur during Cesarean section or soon after birth. The rate of maternal death in pregnancies complicated by PAH is variably reported to be 20–60%. Predictors of cardiac failure during pregnancy are elevated PABP, elevated brain natriuretic peptide (BNP), and elevated RV size. Current PAH-specific therapies have affected survival in nonpregnant PAH patients, and it is important to accumulate data from multiple PAH centers. Prostacyclins became available for PAH treatment in 1996 to the United States and Europe and in 1999 in Japan. Therefore, in this chapter, we classify studies on this condition temporally into pre- and post-PAH therapeutic eras.

Keywords

Pregnancy Pulmonary arterial hypertension Pulmonary vascular disease Right ventricular failure 

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Copyright information

© Springer Science+Business Media Singapore 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologySakakibara Heart InstituteFuchuJapan
  2. 2.Department of Obstetrics and GynecologyMie University Graduate School of MedicineTsuJapan

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