2026-10-12T07:18:27Z https://api.figshare.com/v2/oai

oai:figshare.com:article/34013421 2026-09-28T11:32:16Z category_393 portal_316 item_type_3 month_year_09_2026

Table 1_Pressure-flow discordance in perioperative pulmonary hypertension: a mechanism-based review and provisional five-domain right-heart model for noncardiac surgery.docx Budanbaila La (25122123) Yanyan Bai (5842355) Yiri Du (11947616) Yi Qiu (401057) Ling Wang (56577) Foetal Development and Medicine hemodynamics noncardiac surgery perioperative medicine pressure-flow discordance pulmonary hypertension right ventricle right ventricular failure ventricular-arterial coupling <p>Pulmonary hypertension increases perioperative risk because anesthesia, positive-pressure ventilation, bleeding, and surgical stress can rapidly disturb coupling between the right ventricle and the pulmonary circulation. Pulmonary artery pressure alone cannot distinguish successful unloading from loss of right-ventricular output. This narrative review integrates contemporary guidance, noncardiac surgical cohorts, right-heart physiology, echocardiography, and critical-care evidence and then proposes a provisional five-domain model. The domains are pulmonary vascular load; right-ventricular reserve and ventricular-arterial coupling; systemic perfusion; effective preload and venous congestion; and forward flow and oxygen delivery. The underlying physiology and most component management principles are established; the novel contribution is their longitudinal organization into pressure-flow trajectories, provisional dominant phenotypes, and timestamped intervention-response pairs. Evidence provenance is labeled as guideline or consensus, direct perioperative clinical data, extrapolated physiologic or critical-care evidence, or an unvalidated framework hypothesis. A measurement hierarchy separates quantitative cardiac-output estimates from stroke-volume trends and from downstream perfusion surrogates. Provisional classification requires a core directional pattern plus corroboration from independent domains and permits mixed or indeterminate states. Disease group remains decisive because the same trajectory may imply different hazards in precapillary, postcapillary, lung-disease, or thromboembolic pulmonary hypertension. During controlled instability, one small matched intervention can test the working mechanism; during immediately life-threatening deterioration, parallel resuscitative actions take precedence. The proposed model must demonstrate reproducible classification and incremental value beyond contemporary clinical risk assessment, right-ventricular function, biomarkers, procedure characteristics, and conventional monitoring before it is used as a treatment algorithm.</p> 2026-09-28T11:32:16Z Dataset Dataset 10.3389/fmed.2026.1972194.s001 https://figshare.com/articles/dataset/Table_1_Pressure-flow_discordance_in_perioperative_pulmonary_hypertension_a_mechanism-based_review_and_provisional_five-domain_right-heart_model_for_noncardiac_surgery_docx/34013421 CC BY 4.0