Pulmonary Microvascular Remodeling after Balloon Pulmonary Angioplasty in a Patient with Chronic Thromboembolic Pulmonary Hypertension

Ogawa, Aiko; Kitani, Masashi; Mizoguchi, Hideaki; Munemasa, Mitsuru; Matsuo, Kiyoshi; Yamadori, Ichiro; Andou, Akio; Matsubara, Hiromi

doi:10.2169/internalmedicine.53.1343

Cited by 15 publications

(10 citation statements)

References 10 publications

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“…Our analysis of 29 patients assessed 1 year after PEA did not find improvement between the preoperative and post‐operative DL CO /V A (data not shown). Moreover, microvasculopathy reportedly was unchanged after successful PEA and BPA, despite haemodynamic normalization. These data indicate that microvasculopathy, found to be irreversible despite PEA, may result in decreased DL CO /V A .…”

Section: Discussionmentioning

confidence: 90%

Prognostic and pathophysiological marker for patients with chronic thromboembolic pulmonary hypertension: Usefulness of diffusing capacity for carbon monoxide at diagnosis

et al. 2016

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Background and objective: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease in some patients, despite improved treatments. Microvasculopathy has been implicated in the poor outcomes of patients with CTEPH. A reduction in the diffusing capacity for carbon monoxide (DL CO ) was previously suggested to indicate microvasculopathy in CTEPH patients; therefore, we assessed DL CO /alveolar ventilation (DL CO /V A ) as a prognostic and pathophysiological marker in CTEPH. Methods: We performed a retrospective cohort study of 214 CTEPH patients consecutively diagnosed between 1986 and 2011. After exclusion of 24 patients because of missing DL CO data or severe obstructive impairment, the mortality rates of medically treated patients classified with normal or decreased DL CO values were compared, and prognostic factors were determined. The relationship between long-term surgical outcomes and DL CO /V A was also investigated. Results: Ninety-one inoperable patients were treated medically, two of whom underwent balloon pulmonary angioplasty. Ninety-nine underwent pulmonary endarterectomy. The 5-year survival rate of medically treated patients was significantly lower in patients with decreased DL CO /V A than in those with normal values (61.4% vs 90.4%, P = 0.017). Decreased preoperative DL CO /V A was associated with a smaller percent decrease in post-operative pulmonary vascular resistance, but not with the extent of proximal thrombi; these results may support our hypothesis that DL CO reflects microvascular involvement. Conclusion: Decreased DL CO /V A was associated with poor outcomes of medically treated CTEPH patients; and may be useful for identifying high-risk patients,

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Section: Discussionmentioning

confidence: 90%

Prognostic and pathophysiological marker for patients with chronic thromboembolic pulmonary hypertension: Usefulness of diffusing capacity for carbon monoxide at diagnosis

et al. 2016

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“…The persistent nature of hypoxemia may be due to an irreversible component of the pulmonary arteriopathy. It has been reported that severe pulmonary vascular remodeling persists after epoprostenol therapy [27] and successful balloon pulmonary angioplasty [28]. Reversal of pulmonary artery remodeling might improve both hypoxemia and residual PH and is a goal for future CTEPH treatment.…”

Section: Discussionmentioning

confidence: 99%

Severe Pulmonary Arteriopathy Is Associated with Persistent Hypoxemia after Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension

et al. 2016

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BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is characterized by occlusion of pulmonary arteries by organized chronic thrombi. Persistent hypoxemia and residual pulmonary hypertension (PH) following successful pulmonary endarterectomy (PEA) are clinically important problems; however, the underlying mechanisms remain unclear. We have previously reported that residual PH is closely related to severe pulmonary vascular remodeling and hypothesize that this arteriopathy might also be involved in impaired gas exchange. The purpose of this study was to evaluate the association between hypoxemia and pulmonary arteriopathy after PEA.Methods and ResultsBetween December 2011 and November 2014, 23 CTEPH patients underwent PEA and lung biopsy. The extent of pulmonary arteriopathy was quantified pathologically in lung biopsy specimens. We then analyzed the relationship between the severity of pulmonary arteriopathy and gas exchange after PEA. We observed that the severity of pulmonary arteriopathy was negatively correlated with postoperative and follow-up PaO2 (postoperative PaO2: r = -0.73, p = 0.0004; follow-up PaO2: r = -0.66, p = 0.001), but not with preoperative PaO2 (r = -0.373, p = 0.08). Multivariate analysis revealed that the obstruction ratio and patient age were determinants of PaO2 one month after PEA (R2 = 0.651, p = 0.00009). Furthermore, the obstruction ratio and improvement of pulmonary vascular resistance were determinants of PaO2 at follow-up (R2 = 0.545, p = 0.0002). Severe pulmonary arteriopathy might increase the alveolar-arterial oxygen difference and impair diffusion capacity, resulting in hypoxemia following PEA.ConclusionThe severity of pulmonary arteriopathy was closely associated with postoperative and follow-up hypoxemia.

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“…Moreover, we questioned why, unlike for the coronary arteries, restenosis does not occur despite the fact that ballooning alone is performed without using any stents. Previously, we pathologically examined lesions after BPA and found that the only change in the organized thrombi was a small incision ( 37 ). A subsequent investigation of an autopsy case revealed that BPA had caused dissection of the tunica media in the treated sites, and that the organized thrombi had partially detached from the vascular wall (Figure 3 ) ( 38 ).…”

Section: Mechanism Of Improvement Of Hemodynamics By Bpamentioning

confidence: 99%

Balloon Pulmonary Angioplasty: A Treatment Option for Inoperable Patients with Chronic Thromboembolic Pulmonary Hypertension

Ogawa

Matsubara

2015

Front. Cardiovasc. Med.

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In chronic thromboembolic pulmonary hypertension (CTEPH), stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. CTEPH can be cured surgically by pulmonary endarterectomy (PEA); however, patients deemed unsuitable for PEA due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.

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Pulmonary Microvascular Remodeling after Balloon Pulmonary Angioplasty in a Patient with Chronic Thromboembolic Pulmonary Hypertension

Cited by 15 publications

References 10 publications

Prognostic and pathophysiological marker for patients with chronic thromboembolic pulmonary hypertension: Usefulness of diffusing capacity for carbon monoxide at diagnosis

Prognostic and pathophysiological marker for patients with chronic thromboembolic pulmonary hypertension: Usefulness of diffusing capacity for carbon monoxide at diagnosis

Severe Pulmonary Arteriopathy Is Associated with Persistent Hypoxemia after Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension

Balloon Pulmonary Angioplasty: A Treatment Option for Inoperable Patients with Chronic Thromboembolic Pulmonary Hypertension

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