Pulmonary Hypertension

87 year old presents with severe lower extremity edema. Fixed splitting of S2 with accentuated P2. No rales. Decreased breath sounds of the right base. Severe lower extremity edema does not respond to aldoctone 100 mg POQD and torsemide 40 mg POBID and metolazone 2.5 mg 3 times per week. Transthoracic echocardiogram shows flattening of the septum in systole and diastole, consistent with pulmonary hypertension. Pulmonary artery systolic pressure is 82 millimeters of mercury.