Pulmonary Vasodilators—Treating the Right Ventricle

Pulmonary hypertension remains a significant complication of several systemic and cardiothoracic diseases. It is important to emphasize that the hemodynamic relevance relates to the effect of pulmonary hypertension on right ventricular function and right–left ventricular interaction. The goal of pulmonary vasodilation should focus on optimizing right ventricular function and improving systemic perfusion. The properties of an optimum vasodilator include selective pulmonary vasodilation (avoiding systemic vasodilation), rapid onset of action, short half-life, and ease of administration. Inhaled nitric oxide or nebulization of traditional systemically administered agents offers the greatest clinical promise. An additional merit of selective pulmonary vasodilation consists of augmenting oxygenation by improving ventilation perfusion matching.