Subsequent Specialist Management

Subsequent specialist management
  • Vasodilator testing and calcium-channel blockers
  • Prostanoids
  • Endothelin-receptor antagonists
  • Phosphodiesterase-5-inhibitors
  • Interventional and surgical therapies:
    • Atrial septostomy
    • Lung transplantation

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].