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Marukyan N, Zubarev D, Gorbatykh A, Karimov B, Moiseeva O, Kashtanov M. Carlino-Like Technique for Retrograde Recanalization of Chronic Thromboembolic Pulmonary Artery Occlusion. JACC Cardiovasc Interv 2024; 17:1394-1396. [PMID: 38520456 DOI: 10.1016/j.jcin.2024.01.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Narek Marukyan
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Dmitrii Zubarev
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Artem Gorbatykh
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Boonyod Karimov
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Olga Moiseeva
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Maksim Kashtanov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia.
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Gong S, Li H, Wang L. Pulmonary artery-pulmonary artery collaterals in chronic thromboembolic pulmonary hypertension. Thorax 2024; 79:589-590. [PMID: 38604664 DOI: 10.1136/thorax-2023-221219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Sugang Gong
- Department of Cardio-Pulmonary Circulation, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Huiting Li
- Department of Cardio-Pulmonary Circulation, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
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Hosokawa K, Yamasaki Y, Abe K. Technical Considerations for Performing Safe and Effective Balloon Pulmonary Angioplasty in Patients with Chronic Thromboembolic Pulmonary Hypertension. Interv Cardiol Clin 2023; 12:367-380. [PMID: 37290840 DOI: 10.1016/j.iccl.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a late complication of acute pulmonary thromboembolism owing to incomplete clot dissolution in pulmonary artery. Pulmonary endarterectomy is the first-line treatment for CTEPH. However, 40% of patients are not candidates for surgery because of distal lesions or age. Balloon pulmonary angioplasty (BPA), a catheter-based intervention, is increasingly being used worldwide for treating inoperable CTEPH. Previous BPA strategy had a major concern of reperfusion pulmonary edema as a complication. However, recent refined strategies promise safe and effective BPA. Five-year survival rate after BPA is 90% for inoperable CTEPH, comparable with that of operable CTEPH.
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Affiliation(s)
- Kazuya Hosokawa
- Faculty of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan.
| | - Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
| | - Kohtaro Abe
- Faculty of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
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4
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Li YJ, Pan X, Wang C, He B. Retrograde Approach in Balloon Pulmonary Vein Angioplasty. JACC Cardiovasc Interv 2022; 15:e171-e172. [DOI: 10.1016/j.jcin.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
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Ikeda N, Iijima R, Hara H, Hiroi Y, Nakamura M. Preprocedural frailty is strongly associated with symptoms after balloon pulmonary angioplasty. Glob Health Med 2022; 4:45-51. [PMID: 35291197 PMCID: PMC8884035 DOI: 10.35772/ghm.2021.01019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/18/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
Balloon pulmonary angioplasty (BPA) has improved the survival rate of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The resolution of symptoms is one of the remaining goals of BPA. Frailty affects the outcome of cardiovascular diseases or treatments. The aim of this study is to assess the association between frailty and outcome of BPA. The resolution of symptoms is evaluated by the post-BPA World Health Organization functional class (WHO-FC). A total of 54 patients with CTEPH were divided into 2 groups by post-BPA WHO-FC (WHO-FC I group; n = 34 vs. WHO-FC ≥ II group; n = 20). Frailty was assessed by physicians using the clinical frailty scale (CFS) at the point of patient admission for their first BPA sessions. Compared to the WHO-FC ≥ II group, the WHO-FC I group was younger (65.6 ± 13.9 years vs. 74.3 ± 8.0 years) and had a lower CFS (3 [3, 4] vs. 4 [4, 6]) (median [25th, 75th percentiles]). The WHO-FC I achievement rates for each CFS score were CFS 3: 82.8%; 4: 53.8%; 5: 25.0%; 6: 33.3%; and 7: 20.0%. Logistic regression analysis showed that CFS was an independent predictor of WHO-FC I achievement (odds ratio 0.50, p = 0.012), but pre-BPA hemodynamic parameters and age were not independent predictors. Whether WHO-FC I can be achieved is predicted by pre-BPA patient frailty but not by pre-BPA hemodynamic parameters and age.
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Affiliation(s)
- Nobutaka Ikeda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Raisuke Iijima
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yukio Hiroi
- Division of Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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6
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Marukyan N, Simakova M, Moiseeva O, Kashtanov M. Transbronchial Guidance for Balloon Pulmonary Angioplasty in CTEPH: The Safe Guidewire Passage Through the Occlusion. JACC Cardiovasc Interv 2022; 15:e25-e26. [PMID: 34973910 DOI: 10.1016/j.jcin.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Narek Marukyan
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Maria Simakova
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Olga Moiseeva
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Maksim Kashtanov
- Sverdlovsk Regional Hospital No.1 and Ural Federal University, Yekaterinburg, Russia; Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia.
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7
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Nagai T, Ikeda N, Iijima R, Hara H, Nakamura M. Impact and safety of balloon pulmonary angioplasty for elderly patients. Pulm Circ 2022; 12:e12009. [PMID: 35506078 PMCID: PMC9053002 DOI: 10.1002/pul2.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/22/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022] Open
Abstract
Recently, balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) has become an established procedure with stable results. The number of elderly CTEPH/CTEPD patients has also increased due to the widespread recognition of the disease concept. However, the reports of BPA in the elderly are limited. The aim of this study was to evaluate the efficacy and safety of BPA in elderly patients (>80 years). From April 2016 to December 2020, 344 BPA sessions (74 patients) were performed. The safety and efficacy of the BPA procedures were compared in the younger group (<80 years; 278 sessions) and the elderly group (≥80 years; 66 sessions). The hemodynamic parameters were significantly improved in both groups (mean pulmonary arterial pressure: 34.4 ± 9.9 → 21.2 ± 6.2 mmHg, p < 0.001 and 33.2 ± 9.6 → 21.8 ± 8.5 mmHg, p < 0.001; pulmonary vascular resistance: 474.5 ± 248.6 → 201.3 ± 108.7 dyne sec cm−5, p < 0.001 and 496.4 ± 290.9 → 260.5 ± 120.2 dyne sec cm−5, p = 0.002, in younger and elderly group, respectively). The rate of death within 30 days of BPA (0.3% vs. 0%, p = 1.000) and use of positive pressure ventilation (1.4% vs. 3.0%, p = 0.600) were not different between the groups (younger vs. elderly, respectively). BPA significantly improved the hemodynamic parameters of elderly CTEPH/CTEPD patients, and the safety is comparable to that of younger patients.
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Affiliation(s)
- Taito Nagai
- Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
| | - Nobutaka Ikeda
- Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
| | - Raisuke Iijima
- Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
| | - Hidehiko Hara
- Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
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Toi S, Ikeda N, Iijima R, Hara H, Nakamura M. Successful Transcollateral Bidirectional Balloon Pulmonary Angioplasty in a Patient With Chronic Thromboembolic Pulmonary Hypertension. JACC Cardiovasc Interv 2021; 14:e281-e282. [PMID: 34600877 DOI: 10.1016/j.jcin.2021.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Satoru Toi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobutaka Ikeda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
| | - Raisuke Iijima
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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Tamura M, Kawakami T, Yamada Y, Kataoka M, Nakatsuka S, Fukuda K, Jinzaki M. Successful depiction of systemic collateral supply to pulmonary artery in CTEPH using time-resolved 4D CT angiography: a case report. Pulm Circ 2020; 10:2045894019881065. [PMID: 32328236 PMCID: PMC7163237 DOI: 10.1177/2045894019881065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/06/2019] [Indexed: 11/17/2022] Open
Abstract
A 49-year-old man with CTEPH (pre-procedural mean pulmonary artery pressure:
36 mmHg) underwent balloon pulmonary angioplasty. Chronic total occlusion of the
left inferior pulmonary artery trunk was observed. To evaluate the collateral
vessels of the chronic total occlusion, 4D-CTA was performed. The examination
was performed using a 256-row detector CT system using the test bolus tracking
method. 4D-CTA showed the bronchial artery-to-left inferior pulmonary artery
collateral supply, which was confirmed by a selective bronchial artery
angiography. The patient’s symptoms improved with balloon pulmonary angioplasty
of the other stenotic lesions. 4D-CTA can noninvasively evaluate the anatomy and
hemodynamics of multiple systemic collaterals simultaneously. This technique can
support interventions in systemic artery-to-pulmonary artery collaterals, such
as embolization, and could be helpful in challenging balloon pulmonary
angioplasty interventions for chronic total occlusion to identify vessel
structures distal to the chronic total occlusion and collateral channels for a
retrograde approach.
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Affiliation(s)
- Masashi Tamura
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kawakami
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masaharu Kataoka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seishi Nakatsuka
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Anand V, Frantz RP, DuBrock H, Kane GC, Krowka M, Yanagisawa R, Sandhu GS. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Initial Single-Center Experience. Mayo Clin Proc Innov Qual Outcomes 2019; 3:311-318. [PMID: 31485569 PMCID: PMC6713895 DOI: 10.1016/j.mayocpiqo.2019.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the safety and efficacy of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) seen at a US medical center. Patients and Methods Patients with inoperable or residual postendarterectomy CTEPH who underwent BPA at Mayo Clinic in Rochester, Minnesota, between August 11, 2014, and May 17, 2018, were included. Invasive hemodynamic, clinical, laboratory, and echocardiographic data were collected and analyzed retrospectively. Results We identified 31 patients (26 with inoperable CTEPH and 5 with residual postendarterectomy CTEPH) who underwent 75 BPA procedures performed in a staged manner to reduce complications. The median number of sessions was 2 (interquartile range [IQR], 1-3) per patient, and the number of vessels treated per session was 3 (IQR, 2-3). Of the 31 patients, 24 (77.4%) were taking pulmonary vasodilators and 22 (71.0%) were taking riociguat. The mean pulmonary arterial pressure decreased from 40 mm Hg (IQR, 29-48 mm Hg) to 29 mm Hg (IQR, 25-37 mm Hg; P<.001); pulmonary vascular resistance decreased from 5.5 Wood units (WU) (IQR, 3.0-7.6 WU) to 3.3 WU (2.2-5.2 WU; P<.001). The follow-up 6-minute walk test was performed in 13 patients and improved from 402 m (IQR, 311-439 m) to 439 m (366-510 m; P=.001). Of the 31 patients, 19 (61.3%) had improvement in New York Heart Association functional class. The mean ± SD nadir of minute ventilation/carbon dioxide production decreased by 3.4±5.5 (P=.03), reflecting improved ventilatory efficiency. Complications included hemoptysis requiring overnight intensive care unit observation (n=1) and cardiac tamponade requiring pericardiocentesis (n=1). One patient had reperfusion injury requiring intubation, recovered, and was dismissed to home but died unexpectedly within less than 30 days of the procedure. Serious complications occurred in 3 of the 75 BPA procedures (4.0%). Conclusion Our experience with BPA revealed that this procedure has acceptable risk and improves hemodynamics, functional class, and exercise tolerance in patients with inoperable or residual CTEPH.
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Key Words
- 6MWD, 6-minute walk distance
- BPA, balloon pulmonary angioplasty
- CTEPH, chronic thromboembolic pulmonary hypertension
- ICU, intensive care unit
- IQR, interquartile range
- NT-proBNP, N-terminal pro-B-type natriuretic peptide
- NYHA, New York Heart Association
- PA, pulmonary artery
- PH, pulmonary hypertension
- RAP, right atrial pressure
- RHC, right-sided heart catheterization
- RV, right ventricular
- RVSP, right ventricular systolic pressure
- TAPSE, tricuspid annular plane systolic excursion
- WU, Wood units
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Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Hilary DuBrock
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Michael Krowka
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Allen Ligon R, Petit CJ. Working backward: Retrograde balloon angioplasty of atretic arteries in chronic thromboembolic pulmonary hypertension. Catheter Cardiovasc Interv 2019; 93:1076-1079. [PMID: 30723998 DOI: 10.1002/ccd.28115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/24/2018] [Accepted: 01/20/2019] [Indexed: 11/07/2022]
Abstract
We describe a patient with chronic thromboembolic pulmonary hypertension who presented to the pediatric cardiac catheterization laboratory for peripheral pulmonary artery recanalization and angioplasty. This case report outlines serial pulmonary arterial rehabilitation via a retrograde approach through intrapulmonary collateral arterial connections.
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Affiliation(s)
- R Allen Ligon
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher J Petit
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
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12
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Takei M, Kawakami T, Kataoka M, Kuwahira I, Fukuda K. Residual high intrapulmonary shunt fraction limits exercise capacity in patients treated with balloon pulmonary angioplasty. Heart Vessels 2018; 34:868-874. [PMID: 30460573 DOI: 10.1007/s00380-018-1306-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
Balloon pulmonary angioplasty (BPA) has emerged as a new treatment strategy for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Improvements in hemodynamic parameters after BPA have been reported, but some patients continue to suffer from reduced exercise tolerance even after the normalization of hemodynamic parameters following BPA. As the amelioration of hemodynamic parameters is reportedly achieved via BPA, we hypothesized that the limiting factors for exercise tolerance in these patients are related to respiratory function. Therefore, we investigated the associations between respiratory function and exercise tolerance, and the mechanisms underlying respiratory dysfunction in patients after BPA. We analyzed 62 patients with CTEPH who underwent 1-year follow-up after BPA. Predictors for reduced exercise tolerance after BPA determined with six-minute walk test were sought from pulmonary hemodynamic and respiratory parameters using logistic regression analysis. After multivariate adjustments, high mean right atrium pressure (mRAP) and high alveolar-arterial oxygen gradient (A-aDO2) were significant predictors for reduced exercise tolerance. Next, we analyzed factors associated with high A-aDO2. Among the pathophysiological causes of high A-aDO2, including ventilation, diffusing capacity, and low ventilation-perfusion ratio, only low ventilation-perfusion ratio caused by high intrapulmonary shunt fraction was associated with high A-aDO2. Impaired oxygenation due to residual high intrapulmonary shunt fraction was associated with reduced exercise tolerance in patients with CTEPH, after receiving BPA.
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Affiliation(s)
- Makoto Takei
- Department of Cardiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takashi Kawakami
- Department of Cardiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Masaharu Kataoka
- Department of Cardiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ichiro Kuwahira
- Department of Pulmonary Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
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13
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Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension. Cardiovasc Intervent Radiol 2018; 41:1826-1839. [DOI: 10.1007/s00270-018-2012-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/14/2018] [Indexed: 12/31/2022]
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14
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Lang I, Meyer BC, Ogo T, Matsubara H, Kurzyna M, Ghofrani HA, Mayer E, Brenot P. Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2017; 26:26/143/160119. [PMID: 28356406 PMCID: PMC9489135 DOI: 10.1183/16000617.0119-2016] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/22/2017] [Indexed: 01/26/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH. Balloon pulmonary angioplasty is an emerging percutaneous vascular intervention for non-operable CTEPHhttp://ow.ly/tIN3309hys3
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Affiliation(s)
- Irene Lang
- Dept of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Bernhard C Meyer
- Dept of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Takeshi Ogo
- Division of Pulmonary Circulation, Dept of Advanced Medicine for Pulmonary Hypertension, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiromi Matsubara
- Dept of Clinical Science, National Hospital Organization, Okayama Medical Centre, Okayama, Japan
| | - Marcin Kurzyna
- Dept of Pulmonary Circulation and Thromboembolic Diseases, Medical Centre of Postgraduate Education, European Health Centre Otwock, Otwock, Poland
| | - Hossein-Ardeschir Ghofrani
- Universities of Giessen and Marburg Lung Center, Giessen, Germany, Member of the German Center for Lung Research (DZL).,Dept of Medicine, Imperial College London, London, UK
| | - Eckhard Mayer
- Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
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