肺血管疾病的新分类-英文课件PPT.pptVIP

New Classification of Pulmonary Vascular Disease Treatment Based Classification 1. Pulmonary Arterial Hypertension 2. Pulmonary Venous Hypertension 3. Associated with Disorders of the Respiratory System and/or Hypoxemia 4. Due to Chronic Thrombotic and/or Embolic Disease “Inclusive” New Classification of Pulmonary Hypertension Pulmonary Arterial Hypertension Disorders of the Respiratory System Pulmonary Venous Hypertension “Exclusive” Old Classification of Pulmonary Hypertension PPH SPH Pulmonary Vasuclar Disease:Talk Outline Establishing the Etiology Initial Approach to Treatment Long-term Management Rx: First Treat the Underlying Disease (1) Disorders of the Respiratory System Bronchodialators Oxygen Steriods and Immunosupression Pulmonary Venous Hypertension Afterload Reduction Mitral Valve Surgery Work-Up of Pulmonary Hypertension Pulmonary Arterial Hypertension Pulmonary Venous Hypertension Disorders of the Respiratory System Right Heart Catheterization 1. Diagnosis 2. Determine Prognosis 3. Evaluate Therapy Pathogenesis of Pulmonary Vascular Lesion INSULT INJURY Susceptibility Vascular Lesion Pulmonary Arterial Hypertension 1.1 Primary Pulmonary Hypertension (a) Sporadic (b) Familial 1.2 Related to: (a) Collagen Vascular Disease (b) Congenital Shunts (c) Portal Hypertension (d) HIV Infection (e) Drugs/Toxins Rx: First Treat the Underlying Disease (2) Thromboembolic Disease Anticoagulation IVC Filter Thromboendarterectomy Surgery A Positive Acute Vasodilator Response A reduction in mean pulmonary artery pressure of 10 mmHg associated with either no change or an increase in cardiac output. Executive Summary: World Symposium-Primary Pulmonary Hypertension 1998 The Vasodilator Trial No role for calcium channel blockers Vasodilator Management:Response to Therapy Time PA Pressure Reversible Irreversible The Paradox of Epoprostenol Therapy Patients who do not respond to Epoprostenol in acute vasodilator testing do respond to