Understanding Pulmonary Venous Hypertension: Causes, Diagnosis, and Management

Pulmonary venous hypertension (PVH) is a condition characterized by increased pressure in the pulmonary veins, often stemming from left heart diseases. One notable cause of PVH is the blockage of the left atrium by a myxoma, a benign tumor, or a thrombus, which can obstruct blood flow and elevate venous pressure. Additionally, both congenital and acquired heart lesions significantly contribute to PVH. Congenital conditions such as hypoplastic left heart syndrome, aortic coarctation, interrupted aortic arch, anomalous origin of a coronary artery, valvular aortic stenosis, cor triatriatum, total anomalous pulmonary connection below the diaphragm, and pulmonary vein stenosis or atresia are critical in this context.

PVH leads to a passive rise in pulmonary systolic pressure to maintain blood flow through the vasculature. This increased pressure and volume overload result in shear force injury to the vascular endothelium, initiating vascular remodeling and luminal narrowing. Over time, these changes contribute to a progressive decline in pulmonary function and can lead to right heart failure if untreated.

Diagnosis of PVH involves imaging techniques such as radiographs, pulmonary angiograms, and nuclear medicine perfusion scans. These methods help visualize the structural and functional changes in the pulmonary vasculature. PVH is considered mild with wedge pressures of 10 to 13 mm Hg and moderate with wedge pressures of 14 to 16 mm Hg, accompanied by equalization of blood flow in the upper and lower lobes.

Early identification and management of underlying causes are crucial in mitigating the progression of PVH. Advances in imaging and interventional cardiology have improved diagnostic accuracy and treatment outcomes, highlighting the importance of comprehensive cardiovascular care in managing this complex condition.
Understanding Pulmonary Venous Hypertension: Causes, Diagnosis, and Management