Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Ikeda, Nobutaka

doi:10.1007/s12928-019-00637-2

Cited by 28 publications

(45 citation statements)

References 84 publications

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“…BPA was performed similar to that in previous reports [18,20,31,32]. We placed a short 9-French sheath into the femoral vein and inserted a long 6-French sheath to the main pulmonary artery.…”

Section: Bpa Procedures and Complication Managementmentioning

confidence: 95%

“…Immediately after the patient developed haemoptysis, desaturation, or cough, we started non-invasive positive pressure ventilation (NIPPV) and sealed the injury site with a balloon catheter, using angiography to identify the injury site if necessary. Embolisation was performed using absorbable gelatine sponges (Serescue; Nippon Kayaku Co., Ltd., Tokyo, Japan) for severe haemoptysis in patients with larger or high-flow extravascular leaks that could not be resolved using the above methods [31,32].…”

Section: Bpa Procedures and Complication Managementmentioning

confidence: 99%

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Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy

Ito

Yamashita

Sasaki

et al. 2021

International Journal of Cardiology

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Background: Pulmonary endarterectomy (PEA) is the standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH), although some patients may experience residual pulmonary hypertension (PH). It is unclear whether balloon pulmonary angioplasty (BPA) is effective for residual PH after PEA. This study aimed to compare the BPA outcomes between patients with residual PH after PEA and those with inoperable CTEPH. Methods: This retrospective study compared BPA for residual PH after PEA (25 patients, 101 BPA sessions) and BPA alone for inoperable CTEPH (21 patients, 89 BPA sessions). All patients underwent right heart catheterisation and functional and laboratory tests before PEA or before and after BPA. Results: There was no difference in the number of BPA sessions per patient (4.0 ± 1.9 vs. 4.2 ± 1.9, p = 0.671). No significant differences were observed with respect to the mean pulmonary artery pressure (23.6 ± 9.1 vs. 21.9 ± 5.7 mmHg, p = 0.44), pulmonary vascular resistance (3.7 ± 0.5 vs. 2.8 ± 1.2 Wood units, p = 0.14), 6-min walking distance (392.1 ± 117.7 vs. 452.4 ± 90.1 m, p = 0.096), and World Health Organization functional class (I/II/ III/IV: 14/11/0/0 vs. 9/12/0/0, p = 0.375). Severe haemoptysis requiring embolisation was more common in the PH after PEA group (16.0% vs. 5.4%, p = 0.018). However, no patients required mechanical ventilation or extracorporeal membrane oxygenation, and there were no procedural deaths. Conclusion: Although BPA might be effective for residual PH after PEA, it was associated with a high rate of haemoptysis.

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Section: Bpa Procedures and Complication Managementmentioning

confidence: 95%

Section: Bpa Procedures and Complication Managementmentioning

confidence: 99%

Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy

Ito

Yamashita

Sasaki

et al. 2021

International Journal of Cardiology

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“…BPA has been developed in the last decade, and CTEPH has become a curative disease even in inoperable patients. 18,19 In principle, BPA directly improves pulmonary circulation but does not directly affect systemic arterial stiffness. However, in this case, CAVI was further decreased by additional BPA.…”

Section: Discussionmentioning

confidence: 99%

Increased Arterial Stiffness in Chronic Thromboembolic Pulmonary Hypertension Was Improved with Riociguat and Balloon Pulmonary Angioplasty: A Case Report

Sato¹,

Shimizu²,

Ito³

et al. 2021

IMCRJ

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Background:The role of arterial stiffness in the pathophysiology of chronic thromboembolic pulmonary hypertension (CTEPH) is unclear. The cardio-ankle vascular index (CAVI) is a novel arterial stiffness index reflecting stiffness of the arterial tree from the origin of the aorta to the ankle, independent from blood pressure at the time of measurement. CAVI reflects functional stiffness, due to smooth muscle cell contraction or relaxation, and organic stiffness, due to atherosclerosis. Here, we report the case of a patient with an increased CAVI due to CTEPH and the improvement after riociguat administration and balloon pulmonary angioplasty (BPA). Case Presentation: A 65-year-old man suffered from dyspnea on exertion, and he was diagnosed with distal CTEPH. The mean pulmonary artery pressure (mPAP) was 51 mmHg, and the initial CAVI was 10.0, which is high for patient's age. In addition to right ventricular dysfunction, left ventricular dysfunction was observed as reduced global longitudinal strain (GLS-LV). After riociguat administration, CAVI decreased to 9.1 and GLS-LV improved from −10.3% to −17.3%, although pulmonary hypertension remained (mPAP 41 mmHg). Subsequently, a total of five BPA sessions were performed. Six months after the final BPA, mPAP decreased to 19 mmHg and GLS-LV improved to 19.3%. The patient was symptom free and his 6-minute walk distance improved from 322 m to 510 m. CAVI markedly decreased to 5.8, which is extremely low for his age. Conclusion: These observations suggested that arterial stiffness as measured by CAVI was increased in CTEPH, potentially deteriorating cardiac function because of enhanced afterload. The mechanism of the increase of CAVI in this case of CTEPH was obscure; however, riociguat administration and BPA might improve the pathophysiology of CTEPH partly by decreasing CAVI.

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“…Andererseits wird mittlerweile angezweifelt, ob es sich wirklich um Reperfusionsödeme gehandelt hat oder nicht doch eher um Einblutungen in das Lungengewebe. Ikeada und Mitarbeiter untersuchten eine Patientengruppe im Anschluss an die BPA mittels CT. Sie konnten nachweisen, dass beinahe alle abnormen Verdichtungen im Lungengewebe eng entlang des Pfades des Führungsdrahts zu finden waren [37]. Die Autoren vermuten, dass diese Veränderungen eher Extravasationen nach Drahtperforationen mit Gefäßverletzung entsprechen und eher nicht Reperfusionsödemen, die das gesamte Lungengewebe hinter der behandelten Läsion betroffen hätten [37].…”

Section: Komplikationen Der Pulmonalen Ballonangioplastieunclassified