Summary:
Pulmonary hypertension is defined as the rise of mean pressure in the pulmonary artery over 25 mmHg at rest or over
30 mmHg during activity with accompanying increase of pulmonary vascular resistance over 3 WU (Wood’s unit).
According to the recent WHO classification from 2003 pulmonary hypertension can be categorized as pulmonary
arterial hypertension, pulmonary venous hypertension, hypoxic pulmonary hypertension, chronic thromboembolic
pulmonary hypertension and pulmonary hypertension from other causes. Because symptoms of the pulmonary hypertension
are non-specific, the diagnosis is frequently late. Patients with higher risk of pulmonary hypertension require
frequent echocardiographic examination. Treatment of the pulmonary hypertension is rather complex and economically
demanding. It should be therefore centralized in specialized units. Decision on the pharmacotherapy is based
on the acute pulmonary vasodilatation test. Only patients with the positive test (10% of patients) are indicated to the
treatment with calcium channel blockers. In case of negative test, the treatment of choice in NYHA III stadium is
bosentam per orally, in the NYHA IV stadium it is epoprostenol intravenously. In patients with chronic thromboembolic
pulmonary hypertension, organized thrombotic material should be surgically removed together with the layer of
the pulmonary artery (pulmonary endarterectomy) after preceding anticoagulation treatment lasting at least three
months.
Pulmonary hypertension center of the Cardiocenter of the General teaching hospital is the only unit in the Czech
Republic which beside the complex therapy of the pulmonary arterial hypertension can employ also the surgical
treatment of the chronic thromboembolic pulmonary hypertension.
Key words:
pulmonary hypertension, pulmonary arterial hypertension, chronic thromboembolic pulmonary
hypertension, calcium channel blockers, bosentam, epoprostenol, anticoagulation treatment, pulmonary
endarterectomy.