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2004, Número S1

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Rev Inst Nal Enf Resp Mex 2004; 17 (S1)


Tratamiento quirúrgico de la hipertensión pulmonar: Atrioseptostomía, trasplante pulmonar y tromboendarterectomía

Santibañez-Salgado A, Jasso VR, Olmos-Zúñiga R, Pérez CD, Rey RA, Santillán DP, Villalba CJ

Idioma: Español
Referencias bibliográficas: 59
Paginas: 62-70
Archivo PDF: 82.24 Kb.


RESUMEN

La hipertensión pulmonar primaria sigue una rápida declinación clínica y se asocia a una alta mortalidad. A pesar de los avances en el tratamiento médico, el trasplante de pulmón o corazón-pulmón continúa siendo la mejor opción terapéutica y, la atrioseptostomía únicamente se practica cuando no existe otra opción terapéutica, o bien, como puente al trasplante pulmonar.
La atrioseptostomía es un tratamiento paliativo para los pacientes con hipertensión pulmonar primaria, sus efectos hemodinámicos son: incremento del gasto cardiaco, del índice cardiaco y del transporte sistémico de oxígeno; pero la baja saturación arterial de oxígeno, puede promover isquemia del ventrículo derecho y empeorar la insuficiencia ventricular derecha. La disminución la presión de la aurícula derecha, permite una mejoría de la congestión venosa sistémica, disminución de la ascitis y del edema de miembros inferiores.
El trasplante pulmonar unilateral, el pulmonar bilateral y el del bloque cardiopulmonar son tratamien os exitosos para los pacientes que padecen HAPP. Se considera que un paciente ha alcanzado el "momento del trasplante" cuando la expectativa y calidad de vida son muy malas, pero su estado físico es lo suficientemente bueno para poder sobrevivir al procedimiento.
La hipertensión pulmonar que resulta de la enfermedad tromboembólica, conlleva por sí misma un pobre pronóstico proporcional al grado de hipertensión. El procedimiento quirúrgico está indicado en los pacientes con resistencia vascular pulmonar mayor de 300dinas/s/cm-5 y menores de 500dinas/s/cm-5 en reposo o posterior al ejercicio.
La mayoría de los pacientes sometidos a tromboendarterectomía pulmonar mejoran clínica y hemodinámicamente con normalización de la presión pulmonar y de la resistencia vascular pulmonar, llegando a recuperar una vida normal el 62% de los pacientes.


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