vessel by balloon catheters of appropriate size determined by MDCT or cone-beam CT. The procedure was discontinued when oxygen desaturation was 44% or hemo sputum occurred. We performed BPA in a staged fashion over multiple, separate procedures to maximize efficacy and reduce the risk of reperfusion pulmonary injury. Results: BPA procedure was performed 1-8 times (mean 3.7procedure). mPAP decreased to 14-56mg (mean 27.7mmHg) in all patients. In 10 patients, mPAP improve to under 30mmHg, which was reported to improve prognosis in patients with CTEPH. In 9 patients, the World Health Organization functional class classification improved from III to II. BPA was not defined clinically effective in 5 patients, because mPAP is over 30mmHg in spite of multiple BPA procedure. The duration from PEA to BPA in these four patients was 19-110 months (mean 70.2 months, p¼0.075). Conclusions: BPA for the treatment of the patients with CTEPH after PEA may be feasible and safe. BPA after PEA may be effective if the duration between PEA to BPA was short. Long term follow up is mandatory to confirm the effectiveness of this procedure.
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