How would you treat a patient with combined pre- and post-capillary pulmonary hypertension after successfully optimizing post-capillary pressures through a valvular intervention?

No good data here. First, if I'm contemplating treating this group with pulmonary vasodilators at all, I would like to see repeat RHC demonstrating precapillary pulmonary hypertension with a low wedge. Fixing the valvular disease may help with left-sided function, but many of these patients have dev...

Difficult question with a very nuanced and well-researched answer that I think covers most bases.

I especially agree with the pre-test probability assessment of the patient. If this is a 75 y/o, with AFIB, HTN, etc. and no clear risk factors for group 1 disease, then I would be very reluctant to ins...