Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
- Kataoka M, Inami T, Kawakami T, Fukuda K, Satoh T.
- Balloon Pulmonary Angioplasty (Percutaneous Transluminal Pulmonary Angioplasty) for Chronic Thromboembolic Pulmonary Hypertension. JACC Cardiovasc Interv 2019;12:1382-1388.
The following are key points to remember from this viewpoint article about balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH):
- After CTEPH diagnosis is established, all patients should be evaluated by a comprehensive team of CTEPH experts including pulmonary endarterectomy–experienced surgeons.
- In recent years, therapeutic options for CTEPH patients have expanded with the development of catheter-based interventional therapy, namely BPA.
- European Society of Cardiology and European Respiratory Society guidelines recognize BPA as a therapeutic strategy (Class IIb recommendation) in CTEPH patients with technically inoperable disease or with unfavorable risk-to-benefit ratio for surgery.
- BPA treatment goals are relief of pulmonary hypertension and treatment is considered complete when patients are symptom-free off pulmonary hypertension–specific drugs or no longer have obstructive lesions on pulmonary angiography. BPA for symptom relief in patients without pulmonary hypertension is unproven.
Best practice recommendations:
- BPA should be performed using: 1) Lung perfusion scintigraphy-guidance: right lung > left lung; inferior lobe > superior or middle lobes. 2) Lesion morphology-guidance: “webs and bands” and “abrupt narrowing” > “chronic total occlusion” and “pouch defects.”
- BPA should be staged over multiple sessions limiting contrast and radiation dose exposure (<300 cc and <1 Gy) per session.
- Endpoints for each target lesion are: 1) Pulmonary flow grade 3. 2) Ratio of distal: proximal pressures across the target lesion (detected by pressure wire) >0.8. 3) Mean pulmonary arterial pressure distal to treated lesion does not exceed 35 mm Hg to avoid reperfusion pulmonary edema.
Keywords: Angiography, Angioplasty, Angioplasty, Balloon, Cardiac Surgical Procedures, Cardiology Interventions, Endarterectomy, Heart Failure, Hypertension, Pulmonary, Perfusion Imaging, Pulmonary Edema, Radiation Dosage, Vascular Diseases
< Back to Listings