Pulmonary hypertension is involved in the development of various diseases and therefore it can be caused by several mechanisms from a simple pressure elevation in the pulmonary artery to the serious impairments of pulmonary vessels. The recently increased interest in the problems of
pulmonary hypertension results namely from the new therapeutic means for the treatment of
pulmonary arterial hypertension and chronic thrombembolic
pulmonary hypertension. The algorism of
pharmacotherapy results from the test of acute pulmonary vasodilation. Only the patients with positive test are indicated to the treatment with high doses of
calcium channel blockers. Patients with negative test receive beside the chronic anticoagulation
therapy also a specific
pharmacotherapy (
prostanoids, antagonists of endotheline receptors,
phosphodiesterase 5 inhibitors) with not only vasodilatory but also with antiproliferative and antiaggregatory effects. When all possibilities of
pharmacotherapy are exhausted, balloon atrial septostomy or
lung transplantation should be considered. It has been shown recently that similar pharmacotheraeutic approaches as they are used in patients with
pulmonary arterial hypertension are effective in some cases of other forms of chronic
pulmonary hypertension. Method of choice in the treatment of chronic thromboembolic
pulmonary hypertension is the pulmonary
endarterectomy in patients with surgically curable thrombotic obstruction. In patients who are not suitable for surgical treatment it is necessary to try
pharmacotherapy (prostacycline,
bosentan,
sildenafil) or
lung transplantation. Complicated diagnosis and
therapy of
pulmonary hypertension requires concentrating the treatment into specialized centres with multidisciplinary background and sufficient experience. In the Czech Republic, the care of patients with
pulmonary hypertension is concentrated into the Cardio Center of the 2nd Medical Department of the 1st Faculty of Medicine and General Teaching Hospital in Prague and into the Cardio Center of the Institute of Clinical and Experimental Medicine in Prague. Complex care to patients with chronic thromboembolic
pulmonary hypertension is given at the Cardio Center of the General Teaching Hospital in Prague, where since September 2004, 99 patients were surgically treated with results comparable to the best similar departments abroad.