Alternatives to lung transplantation: treatment of pulmonary arterial hypertension.

The development of targeted therapies for pulmonary arterial hypertension currently based on prostaglandin, nitric oxide, and endothelin pathways has resulted in major advances in the treatment of patients with pulmonary arterial hypertension. This article reviews the current evidence that supports both the use of mono- and combination therapy. The article also considers the role of atrial septostomy in the treatment of pulmonary arterial hypertension, particularly as a bridge to transplantation. Finally, the article provides a review of the role and outcomes of pulmonary thromboendartertectomy for patients with chronic thromboembolic pulmonary hypertension.