The pathogenesis of pulmonary hypertension — vessel wall ischemia as the driving force in disease initiation and progression

Surgeons are not trained to decipher the pathogenesis of diseases, which they operate on. They are used to repair, remove, or replace defective tissues and organs. Yet, we often see typical pathomorphological or pathophysiological phenomena, characteristic of a specific disorder that can only be observed during surgery. Such patterns would not be recognized easily by current imaging techniques, and their visibility would require a living organism. In modern terminology, one could call them “surgical biomarkers”. Many disease entities, today, are still not completely deciphered regarding initial links of their pathogenesis, despite decades of experimental and clinical research. In such disorders, characteristically named “idiopathic”, surgical observations may be helpful to clarify disease mechanisms, two of which we offer here for one of these disease entities, namely pulmonary hypertension.