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Pulmonary Hypertension

Abstract

Recommended Article

Advances in therapeutic interventions for patients with pulmonary arterial hypertension Prognostic Effect and Longitudinal Hemodynamic Assessment of Borderline Pulmonary Hypertension Pulmonary artery denervation to treat pulmonary arterial hypertension: the single-center, prospective, first-in-man PADN-1 study (first-in-man pulmonary artery denervation for treatment of pulmonary artery hypertension) Microvascular disease in chronic thromboembolic pulmonary hypertension: a role for pulmonary veins and systemic vasculature Right ventricular stroke work correlates with outcomes in pediatric pulmonary arterial hypertension Haemodynamic definitions and updated clinical classification of pulmonary hypertension Pulmonary artery denervation for treatment of a patient with pulmonary hypertension secondary to left heart disease Medical Therapy for CTEPH: Is There Still Space for More?
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Clinical Trial 2001 Jan 2;103(1):10-3.

JOURNAL：Circulation. Article Link

Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension

Feinstein JA, Goldhaber SZ, Lock JE et al. Keywords: Balloon pulmonary angioplasty; chronic thromboembolic pulmonary hypertension

Abstract

BACKGROUND - Although pulmonary thromboendarterectomy is increasingly successful for the definitive treatment of chronicthromboembolic pulmonary hypertension (CTEPH), not all patients have surgically accessible disease. Others are poor surgical candidates because of comorbid illness. Therefore, for selected patients, we defined and implemented an alternative interventional strategy of balloon pulmonary angioplasty (BPA).

METHODS AND RESULTS - Eighteen patients (mean age, 51.8 years; range, 14 to 75 years) with CTEPH underwent BPA; they averaged 2.6 procedures (range, 1 to 5) and 6 dilations (range, 1 to 12). Selection of pulmonary artery segments for dilation required (1) complete occlusion, (2) filling defects, or (3) signs of intravascular webs. After an average of 36 months of follow-up (range, 0.5 to 66 months), the average New York Heart Association class improved from 3.3 to 1.8 (P:<0.001), and 6-minute walking distances increased from 209 to 497 yards (P:<0.0001). Pulmonary artery mean pressures decreased from 43.0+/-12.1 to 33. 7+/-10.2 mm Hg (P:=0.007). Eleven patients developed reperfusion pulmonary edema; 3 required mechanical ventilation.

CONCLUSIONS - BPA reduces pulmonary artery hypertension in patients with CTEPH and is associated with long-term improvement in New York Heart Association class and 6-minute walking distances. BPA is a promising interventional technique that warrants randomized comparison with medical therapy in CTEPH patients who are not surgical candidates.

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