RESUMEN

La hipertensión arterial pulmonar (HAP) es una enfermedad incapacitante, progresiva y hasta ahora incurable. No hay duda que el tratamiento farmacológico ha modificado de manera favorable la calidad de vida y posiblemente la supervivencia (SV) de los enfermos. Sin embargo, no todos los pacientes responden al tratamiento médico ni tampoco existe disponibilidad universal de los fármacos empleados. Para los enfermos refractarios al tratamiento farmacológico existen dos alternativas: la septostomía auricular (SA) y el trasplante pulmonar (TP) y cardiopulmonar (TCP).
La SA es un procedimiento intervensionista paliativo que descomprime las cavidades derechas del corazón y aumenta el gasto cardiaco de los pacientes a través de la creación de un cortocircuito (shunt) interauricular. Produce una disminución de la saturación de oxígeno que es compensada por el incremento del transporte de oxígeno. Aunque no existen estudios clínicos controlados, el procedimiento mejora la calidad de vida y posiblemente la SV de los pacientes con falla ventricular derecha refractaria a tratamiento médico. La SA se ha utilizado también como puente para trasplante. El procedimiento, no exento de riesgo, debe realizarse en centros especializados.
El TP y TCP representan en la actualidad la última opción en el tratamiento de la HAP. Las indicaciones y el tiempo óptimo para realizarlo son decisiones ahora más complejas ante el relativo éxito del tratamiento médico. La supervivencia pos TP está limitada por el rechazo tardío en la forma de bronquiolitis obliterante, sin embargo, en los que sobreviven, la mejoría en calidad de vida puede ser extraordinaria.

PALABRAS CLAVE

Hipertensión pulmonar, septostomía auricular, trasplante pulmonar.

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