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Pulmonary HTN (Poor prognosis if: (Poor functional status, Right…

- - - - Connective tissue (scleroderma, SLE)
      - HIV
      - Portal HTN
      - Congenital heart disease
  - - - Eisenmenger syndrome - reversed or bidirectional cardiac shunt
      - Interventricular, interarterial or aortopulmonary
    - - AV shunts, intracardiac shunts
      - Exacerbated by pregnancy
- - - - Mild - rarely impacts on anaes management
      - Mod-severe - can lead to acute right heart failure and shock
      - Functional status
      - History of syncope suggests low cardiac output
      - Hypoxia
    - - High periop mortality
      - NYHA IV: median survival 6 months
    - - Laparoscopic poorly tolerated
      - Liver transplant mort 80% if mPAP >45
      - Rapid blood loss poorly tolerated
      - Specific risks: embolisation air, bone, amniotic fluid
    - - Liaise with resp specialist (consider PDE3 inhibitor (milrinone) or PDE5 (Sildenafil)
      - Consider delaying until heart/lung transplant
      - Optimise underlying disease