A common classification for both paediatric and adult patients was adopted. The most recently updated version proposed during the fifth WSPH held in Nice, France in 2013 is presented in table 1. This new classification enabled well-designed randomised controlled trials conducted in clearly defined patient populations, which have led to the approval of eight drugs for the treatment of PAH.ДЄt a further WSPH, the clinical classification was refined, while the general architecture of previous classifications was maintained. Pulmonary hypertension with unclear multifactorial mechanisms.Chronic thromboembolic pulmonary hypertension (CTEPH).Pulmonary hypertension due to chronic lung diseases and/or hypoxia.Pulmonary hypertension due to left-sided heart diseases (LHD).Five well-defined major categories of PH were created, and based on similar underlying pathophysiological mechanisms: Twenty-five years later at the second World Symposium on Pulmonary Hypertension (WSPH) held in Evian, France in 1998, a remarkable modification of the previous classification was adopted. The original World Health Organization (WHO) clinical classification of PH proposed in 1973 was simple and based on only two categories: primary and secondary PH. Pulmonary hypertension (PH) is a condition frequently encountered in daily clinical practice and, despite the lack of good prevalence data, it is presumed to be the third most common cardiovascular condition after systemic hypertension and coronary artery disease. Pulmonary hypertension, right heart catheterisation, pulmonary vascular resistance Recent data suggest that invasive pulmonary haemodynamic measurement during exercise may be more sensitive than resting haemodynamics for early diagnosis, for treatment response assessment and for prognostic purposes. Acute vasoreactivity testing is indicated only in selected patients. Because pressure and flow determinations with a fluid-filled flow-directed thermodilution catheter are potentially insufficiently precise, it is recommended to average at least three measurements. Obese patients and patients with obstructive lung diseases require special attention, given that spontaneous positive end-expiratory intrathoracic pressures are frequently observed. During right heart catheterisation correct zero levelling of the external pressure transducer and pressure tracing readings at end-expiration should be assured. The correct acquisition and interpretation of invasive pulmonary haemodynamic variables play a central role, not only in confirming the diagnosis but also in prognostication and treatment decision-making. Pulmonary artery wedge pressure assessment has a pivotal role in differentiating precapillary from postcapillary pulmonary hypertension. The definitive diagnosis and classification of pulmonary hypertension requires invasive confirmation of an elevated pulmonary artery mean pressure during a right heart catheterisation at rest. The diagnostic approach to pulmonary hypertension is supported by a proposed algorithm, which identifies the underlying cause. Transthoracic echocardiography represents the first and most important noninvasive screening tool for estimating the probability of pulmonary hypertension.

Current clinical classification of pulmonary hypertension considers five distinct groups. The term pulmonary hypertension refers to a serious condition characterised by high pulmonary vascular pressure, mainly as a consequence of various cardiac and respiratory diseases. A Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC), Intensive Care Unit of Regional Hospital of Mendrisio and Lugano, SwitzerlandД« Unit of Clinical Epidemiology of EOC, Bellinzona, SwitzerlandД¬ Division of Pneumology, University of Geneva, SwitzerlandД Pneumology, Department of Internal Medicine, Regional Hospital of Lugano, SwitzerlandД® Pulmonary Hypertension Programme, University of Geneva, SwitzerlandДЇ Paediatric Cardiology Unit, ChildrenвЂ™s University Hospital, University of Geneva, Switzerland

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