Surgery to treat pulmonary hypertension!!

Although Pulmonary hypertension (PH) is managed medically most times, surgery may play a role in certain circumstances:
1- Atrial Septostomy: palliative procedure 2 Create a right-to-left shunt in cases of severe right heart failure refractory to medical Rx.
2- Pulmonary Thromboendarterectomy :maybe done in specialized centers in cases of chronic thromboembolic PH.
3- transplantation: either lung or heart-lung transplantation. Reserved for suitable pts that remain in advance functional class despite maximal medical Rx.
4- surgical or percutaneous correction of congenital systemic to pulmonary shunts causing PH in selected cases