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How to manage pulmonary embolism and pulmonary hypertension in pregnancy?

On Sunday evening (Meet the Experts session, Stockholm - Zone 4), a panel of five European experts in pulmonary hypertension challenged the new joint ERS/ESC Guidelines for pulmonary hypertension discussing treatment decisions in real-life cases. 

Important contents of the current guidelines were reiterated. For example, in a Belgian case of a 77-year old gentleman with coronary disease presenting with newly manifest severe pulmonary arterial hypertension, the key observation of a “true” hemodynamic responder, i.e., an individual decreasing pulmonary arterial mean pressure by 10mmHg absolute, and below 40mmHg, in the absence of systemic hypotension, was discussed. While the patient fulfilled these criteria, the response was not maintained at 3 months, an observation which is generally to be expected in this age category, as was confirmed by Prof Sitbon (France) from the PH center in Clamart, France. 

The second case of a young Italian woman with presumably hereditary pulmonary arterial hypertension raised the important question of first-line treatment for pulmonary arterial hypertension that is not specified in the current version of the new guidelines. 

However, most importantly, these new guidelines are the first to introduce the concept of reassessing treatment goals after 3-6 months following introduction of a new treatment. Thus, in the case of both patients discussed in this session, rapid optimization of treatments was attained, despite the controversy about initial diagnostic and therapeutic steps. 

“There will be amendments and free space for improvements” concluded the leading author of the guidelines, Prof Nazareno Galie, “but as our practice shows, we have been tailoring patient care according to the directions that are provided herein”. 




How to manage pulmonary embolism and pulmonary hypertension in pregnancy?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.