Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension

Pablo Sepúlveda; Juan Ortega; German Armijo; José Torres; Pablo Ramírez; Christian Backhouse; César Vargas; Leonel López; Felipe González; Ángel Puentes; Hernán Donoso; Augusto Bellet; Diego Godoy; Mario Araya; Carmen Luz Andrade; et. al.

Keywords: pulmonary embolism, angioplasty, hypertension, pulmonary

Abstract

Background: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Aim: To report the initial experience with the "refined BPA technique" with the use of intravascular images. Patients and Methods: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. Results: We performed 16 BPA in eight patients aged 61 +/- 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 +/- 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 +/- 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 +/- 377,0 at baseline to 516,6 +/- 323,3 Dynes/sec/cm(-5) (p<0.01) and the cardiac index increased from 2.4 +/- 0.6 at baseline to 2.8 +/- 0.3 L/min/m(2) (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3 +/- 0.5 to 2.5 +/- 0.5 (p<0,01) and six minutes walking distance from 331 +/- 92 to 451 +/- 149 m (p=0.01). Conclusions: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.

Más información

Título según WOS: Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension
Título según SCOPUS: Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension [Angioplastía con balón para el tratamiento de la hipertensión arterial pulmonar por enfermedad tromboembólica crónica. Resultados hemodinámicos y clínicos inmediatos]
Título según SCIELO: Angioplast�a con bal�n para el tratamiento de la hipertensi�n arterial pulmonar por enfermedad tromboemb�lica cr�nica. Resultados hemodin�micos y cl�nicos inmediatos
Título de la Revista: REVISTA MEDICA DE CHILE
Volumen: 147
Número: 4
Editorial: SOC MEDICA SANTIAGO
Fecha de publicación: 2019
Página de inicio: 426
Página final: 436
Idioma: Spanish
DOI:

10.4067/S0034-98872019000400426

Notas: ISI, SCIELO, SCOPUS