RESUMEN

La hipertensión arterial pulmonar se define como la presencia de presión pulmonar media › 25 mmHg en reposo o 30 mmHg durante el ejercicio. El incremento de la presión pulmonar puede ser el resultado de la elevación en la resistencia vascular pulmonar o del flujo sanguíneo pulmonar; sin embargo, aún teniendo un incremento muy significativo en el flujo sanguíneo pulmonar rara vez produce una elevación grave de la presión pulmonar a menos que coexistan cambios patológicos vasculares. El cateterismo cardiaco derecho es el estándar de oro y debe realizarse en todos aquellos pacientes que se están estudiando por hipertensión arterial pulmonar, no sólo confirma la presencia de la enfermedad, sino también es útil en el diagnóstico diferencial, evalúa la severidad de la hipertensión y sobre todo es posible determinar un factor pronóstico a través de la respuesta que se obtiene durante la administración de vasodilatadores. Los vasodilatadores que en la actualidad se utilizan durante la prueba de reactividad vascular pulmonar son adenosina, prostaciclina o análogos y óxido nítrico. Los pacientes considerados con respuesta son aquéllos en los cuales hay una disminución en la presión pulmonar media ≤ 40 mmHg, o cuando menos del 10% de la misma; la prueba es útil para justificar el efecto benéfico de bloqueadores de canales de calcio por tiempo prolongado.

PALABRAS CLAVE

Cateterismo cardiaco derecho, respuesta vascular pulmonar, hipertensión arterial pulmonar, presión media pulmonar, presión diastólica final del ventrículo derecho.

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