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KMID : 0191120180330040024
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Journal of Korean Medical Science
2018 Volume.33 No. 4 p.24 ~ p.24
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Impact of Balloon Pulmonary Angioplasty on Hemodynamics and Clinical Outcomes in Patients with Chronic Thromboembolic Pulmonary Hypertension: the Initial Korean Experience
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Kwon Woo-Chan
Yang Jeong-Hoon
Park Taek-Kyu
Chang Sung-A
Jung Dong-Seop
Cho Young-Seok
Kim Sung-Mok
Kim Tae-Jung
Park Hye-Yoon
Choi Seung-Hyuk
Kim Duk-Kyung
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Abstract
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Background: The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). However, not all patients are eligible for PEA, and some patients experience recurrence of pulmonary hypertension even after PEA.
Methods: Patients who underwent balloon pulmonary angioplasty (BPA) between December 2015 and April 2017 were enrolled from the Samsung Medical Center CTEPH registry. Enrolled patients underwent right heart catheterization, echocardiography, and 6-minute walk distance (6MWD) at baseline, 4 and 24 weeks after their first BPA session. We compared clinical and hemodynamic parameters at the baseline and last BPA session.
Results: Fifty-two BPA sessions were performed in 15 patients, six of whom had a history of PEA. BPA resulted in improvements in World Health Organization (WHO) functional class (2.9 ± 0.8 to 1.7 ± 0.6, P = 0.002), 6MWD (387.0 ± 86.4 to 453.4 ± 64.8 m, P = 0.01), tricuspid annular plane systolic excursion (14.1 ± 3.6 to 15.6 ± 4.3 mm, P = 0.03) and hemodynamics, including a decline in mean pulmonary artery pressure (41.1 ± 13.1 to 32.1 ± 9.5 mmHg, P < 0.001) and in pulmonary vascular resistance (607.4 ± 452.3 to 406.7 ± 265.4 dyne.sec.cm?5,P = 0.01) but not in cardiac index (2.94 ± 0.79 to 2.96 ± 0.93 L/min/m2,P = 0.92). Six cases of complications were recorded, including two cases of reperfusion injury.
Conclusion: BPA might be a safe and effective treatment strategy for both inoperable CTEPH patients and patients with residual pulmonary hypertension after PEA.
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KEYWORD
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Chronic Thromboembolic Pulmonary Hypertension, Balloon Pulmonary Angioplasty, Pulmonary Endarterectomy
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