Pulmonary Edema Predictive Scoring Index (PEPSI), a New Index to Predict Risk of Reperfusion Pulmonary Edema and Improvement of Hemodynamics in Percutaneous Transluminal Pulmonary Angioplasty

Inami, Toru; Kataoka, Masaharu; Shimura, Nobuhiko; Ishiguro, Haruhisa; Yanagisawa, Ryoji; Tanaka, Hiroki; Fukuda, Keiichi; Yoshino, Hideaki; Satoh, Tsuyoshi

doi:10.1016/j.jcin.2013.03.009

Cited by 171 publications

(135 citation statements)

References 35 publications

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“…Pulmonary tissue surrounding pulmonary arteries offers little resistance to bleeding in cases of iatrogenic vascular injury. Extravasated blood may invade either the bronchial system or pulmonary interstitium [6,9,10]. Also, dilatation of a significant stenosis of a medium-sized pulmonary artery may result in local reperfusion oedema.…”

Section: Discussionmentioning

confidence: 99%

“…A reperfusion lung injury was based on Inami classification [10]. A grade 3 was defined as moderate reperfusion pulmonary oedema that needed an elevated concentration of oxygen administered via an oxygen mask to maintain arterial saturation at the optimum level.…”

Section: Assessment Of Complicationsmentioning

confidence: 99%

“…Both reports mentioned specific complications related to this procedure. Meanwhile, several Japanese centres gained their own experience in BPA using slightly different methodologies and claimed reduced complication rates while maintaining high efficacy [7][8][9][10][11][12][13][14]. We started to perform BPA in non-operable CTEPH patients in 2013 [15,16], motivated by their expected poor survival compared with those offered surgical PEA [2].…”

Section: Introductionmentioning

confidence: 99%

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Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Kurzyna¹,

Darocha²,

Pietura³

et al. 2017

Kardiol Pol

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A b s t r a c t Background and aim:To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve "web" and "ring" lesions using reduced tip load guidewires and less intensive anticoagulation.Results: There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with > 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p < 0.001).Conclusions: Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.

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Section: Discussionmentioning

confidence: 99%

Section: Assessment Of Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Kurzyna¹,

Darocha²,

Pietura³

et al. 2017

Kardiol Pol

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“…14) According to this report, the index is related to the development of RPE and both the change in angiographic flow and the baseline severity of PH. To avoid vessel injury and widespread pulmonary edema, we performed BPA using a small balloon (2.0 mm in diameter), and limited the area within the right middle or lower lobes.…”

Section: Discussionmentioning

confidence: 99%

Rescue Balloon Pulmonary Angioplasty Under Veno-Arterial Extracorporeal Membrane Oxygenation in a Patient With Acute Exacerbation of Chronic Thromboembolic Pulmonary Hypertension

et al. 2015

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SummaryWe describe a case of a 41-year-old woman with acute exacerbation of chronic thromboembolic pulmonary hypertension (CTEPH) complicated by rapidly progressive respiratory failure and right heart failure with cardiogenic shock. A computed tomography (CT) showed thrombi in the right main pulmonary artery and bilateral peripheral pulmonary arteries, and echocardiography showed right ventricular dilatation and tricuspid regurgitation, with an estimated pressure gradient of 80 mmHg. The patient was initially diagnosed with acute pulmonary thromboembolism, and thrombolytic therapy was administered. Her condition subsequently deteriorated, however, necessitating mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We performed emergency catheter-directed thrombectomy and thrombus aspiration. Pulmonary hypertension (PH) temporarily improved, but subsequently worsened, and the patient was diagnosed with CTEPH. Pulmonary endarterectomy (PEA) was performed. After PEA, we were unable to wean the patient off VA-ECMO, and rescue balloon pulmonary angioplasty (BPA) to the middle and inferior lobe branches of the right lung was performed. Five days after BPA, the patient was removed from VA-ECMO and on the 57th day of hospitalization, she was weaned off the ventilator. The patient was discharged after 139 days of hospitalization. Rescue BPA represents a useful intervention for improving PH and weaning off VA-ECMO in a patient with acute exacerbation of CTEPH. (Int Heart J 2015; 56: 116-120) Key words: Right heart failure, Pulmonary endarterectomy, BPA, ECMO, CTEPH C hronic thromboembolic pulmonary hypertension (CTEPH) is caused by organized pulmonary thrombosis, and is considered to progress, at least in part, from acute pulmonary thromboembolism, though the exact etiology remains unknown. Five-year survival rates in patients with a mean pulmonary artery pressure (PAP) less than 30 mmHg is approximately 90%; a mean PAP over 50 mmHg confers a survival rate of approximately 10%, and very poor prognosis.1) Pulmonary endarterectomy (PEA) in patients with CTEPH can markedly decrease PAP and improve prognosis. 2)In peripheral types of CTEPH, however, PEA is ineffective and associated mortality rates are high. Recently, the efficacy of balloon pulmonary angioplasty (BPA) in inoperable CTEPH patients was reported.3) We successfully employed BPA under veno-arterial extracorporeal membrane oxygenation (VA-EC-MO) in a patient with acute exacerbation of CTEPH that did not improve with PEA. Case ReportA 41-year-old woman presented at our hospital with dyspnea, edema, and weight gain. She had suffered from epilepsy since the age of 16, and at 36 had exhibited multiple lacunar infarctions on magnetic resonance imaging (MRI). She was a heavy smoker (40 cigarettes per day for 20 years), but had no family history of thromboembolic disease or blood coagulation disorders. She was taking phenytoin 100 mg tid, valproic acid 400 mg qid, and aspirin 100 mg sid.On admission, her blood pressure was 102/58 mmHg...

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“…Единственным доступным методом после неуспешной ТЛТ в центре была ангиопластика с фрагментацией тромба в легочной артерии. Несмотря на кажущуюся легкость этой процедуры, надо учитывать трудности, возникающие при ее проведении: невозможность или опасность тугого контрастирования легочных ар-терий, распространенное поражение ее ветвей, рубцо-вый процесс в артериях, связанный с неоднократными эпизодами ТЭЛА [16,17]. После ангиопластики у па-циентов может развиться реперфузионный отек лег-ких, причины которого до конца неясны [17].…”

Section: описание случаяunclassified

A Two-Year Follow-Up of a Female Patient With Recurrent Pulmonary Thromboembolism After Successful Combined Treatment

Баранова¹,

Zaikina²,

Соколова³

et al. 2015

Klinicist

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Pulmonary Edema Predictive Scoring Index (PEPSI), a New Index to Predict Risk of Reperfusion Pulmonary Edema and Improvement of Hemodynamics in Percutaneous Transluminal Pulmonary Angioplasty

Abstract: Pulmonary Flow Grade score is useful in determining therapeutic efficacy, and PEPSI is highly supportive to reduce the risk of RPE after PTPA. Using these 2 indexes, PTPA could become a safe and common therapeutic strategy for CTEPH.

Cited by 171 publications

References 35 publications

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Rescue Balloon Pulmonary Angioplasty Under Veno-Arterial Extracorporeal Membrane Oxygenation in a Patient With Acute Exacerbation of Chronic Thromboembolic Pulmonary Hypertension

A Two-Year Follow-Up of a Female Patient With Recurrent Pulmonary Thromboembolism After Successful Combined Treatment

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