Subsequent Specialist Management

Because of the expertise required, specialist centres prefer to initiate the interventions outlined in the Table, right.

Regarding subsequent (specialist) management, there has been recent interest in using a combination of drugs with different mechanisms of action for the management of PH. For example, phosphodiesterase inhibitors may enhance and prolonged the effects of prostanoids [1].

Similar to drug treatment of essential hypertension and cancer, combination drug therapy potentially enhances drug efficacy and may permit individual drugs to be used at lower doses, minimizing drug toxicity [1].

Regarding the interventional and surgical therapies for PH, atrial septostomy is generally used as a palliative procedure or as a stabilizing bridge to lung transplantation[18].