Postoperative Pulmonary Hypertension

Case Synopsis

A 50-year-old woman with chronic thromboembolic pulmonary hypertension is to undergo open partial colectomy with primary reanastomosis for colonic adenocarcinoma. She is on warfarin therapy, which she was instructed to stop 7 days before surgery. She is on no other medications for pulmonary hypertension. She is able to walk less than one block before she needs to stop because of dyspnea. Her preoperative echocardiogram showed moderate-to-severe pulmonary hypertension. Her last right-sided heart catheterization was 6 years ago. Mean pulmonary arterial pressure at that time was 40 mm Hg. A pulmonary artery catheter was placed after induction due to the patient’s past medical history. The case was uneventful, and the patient was recovered in the postanesthesia care unit (PACU). Twenty minutes into her PACU course, her heart rate increases from 85 to 120, and her blood pressure is now 70/35. Her Sp o ₂ on 100% O ₂ at 10 L/min is 92%. Her temperature is 36.5°C. Her pulmonary artery catheter showed her pulmonary artery pressure to be 75/45 mm Hg, an increase from her baseline of 45/28 mm Hg. She was reintubated in the PACU. A transesophogeal echocardiogram (TEE) was performed, revealing a severely dilated right ventricle, the intraventricular septum bulging into the left ventricle, and a hypovolemic left ventricle.