Pulmonary Hypertension - Clinical Services
Patients with all types of pulmonary hypertension, including the most complex cases, can find exceptional treatment at the University of Minnesota. While pulmonary hypertension has no cure, our medical team can greatly relieve symptoms and improve a patient’s quality of life.
We use the gold standard for diagnosing pulmonary hypertension, which is right heart catheterization. With this procedure, performed by an interventional cardiologist, a small catheter is threaded from the jugular or femoral vein to the right side of the heart so the physician can measure pressure within the heart and pulmonary vessels. Pulmonary hypertension typically is diagnosed when the average pressure in the pulmonary arteries is higher than 25 mmHg at rest. Normally, that pressure would be between 8 and 20 mmHg at rest.
The World Health Organization has divided pulmonary hypertension into five groups based on the cause of the condition:
Group 1. This includes conditions with no known cause or those that might be inherited as well as those caused by drugs or toxins; conditions such as connective tissue disease, HIV, liver disease, congenital heart disease, sickle cell disease or infection from a parasite; or those caused by conditions that affect the small blood vessels of the lungs. Patients in this group can often be treated with oral, inhaled or intravenous medications, but sometimes they require more substantial medical procedures. These include:
- Atrial septostomy. A catheter is threaded through the wall of the heart that separates the two atria, and a balloon is inflated to create an opening, relieving pressure on the right atria.
- Lung or heart-lung transplant. The University of Minnesota has one of the largest and most successful lung transplant programs in the United States, with survival rates that exceed the national average. Our physicians have performed more than 700 lung and heart-lung transplants. We have been pioneers in this important surgery, having performed the first lung transplant and the first heart-lung transplant in Minnesota. We also were the first in Minnesota to use a living donor for a lung transplant and the first to perform a “breathing lung” transplant, keeping donated lungs warm and breathing before transplant.
Group 2. Patients with left heart disease that could be caused by valvular heart disease, long-term high blood pressure and stiffing of the heart, or cardiomyopathy. Many of these patients can be treated with lifestyle changes, medications or surgery.
Group 3. Patients whose pulmonary hypertension falls into this group tend to have lung diseases, such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease, which causes scarring of lung tissue. Patients in this group also may have sleep apnea. Treatment usually starts with oxygen therapy and may progress to medications or surgery, if indicated.
Group 4. Patients with pulmonary hypertension caused by blood clots in the lungs or a blood-clotting disorder. Surgical thromboendarterectomy is the treatment of choice. Patients who are not candidates for surgery are treated with medications that reduce pressure in the lungs and blood thinners.
Group 5. Patients with a variety of other diseases or conditions that might include blood, systemic or metabolic disorders. They also might have kidney disease or tumors that press on the pulmonary arteries. Successful treatment of the underlying condition often reduces the pulmonary hypertension.