Perioperative Use of Pulmonary Artery Catheter in a Patient With Severe Chronic Thromboembolic Pulmonary Hypertension Undergoing Major Gynecological Surgery: A Case Report

Pulmonary hypertension (PH) is associated with substantial perioperative risk in noncardiac surgery. In chronic thromboembolic pulmonary hypertension (CTEPH), persistent elevation of pulmonary vascular resistance (PVR) imposes considerable mechanical load on the right ventricle (RV), limiting its ability to tolerate acute physiologic changes. We report the successful management of a 52-year-old woman with severe CTEPH undergoing total hysterectomy and bilateral salpingo-oophorectomy. Comprehensive preoperative assessment, meticulous intraoperative management, and continuous hemodynamic monitoring with a pulmonary artery catheter (PAC) enabled tight control of pulmonary pressures without vasopressor support. Under low-dose glyceryl trinitrate infusion and PAC-guided titration of therapy, her mean pulmonary artery pressures (mPAP) remained stable throughout surgery and the early postoperative period. She experienced an uneventful recovery and was discharged home on postoperative day eight. This case underscores the critical role of meticulously tailored anesthetic management and advanced monitoring (PAC) in ensuring optimal outcomes for patients with severe PH undergoing noncardiac surgery.