Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Medical Centre for Postgraduate Education, Otwock, Poland.
Int J Cardiol. 2019 Mar 1;278:232-237. doi: 10.1016/j.ijcard.2018.10.066. Epub 2018 Oct 25.
Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). However, persistent pulmonary hypertension continues in 5-35% of patients after PEA. Recently, balloon pulmonary angioplasty (BPA) showed promise as a strategy for patients with non-operable CTEPH. Therefore, we investigated the usefulness of BPA for residual pulmonary hypertension after PEA.
Fifteen patients with residual pulmonary hypertension after PEA received 71 BPA sessions (4.7 ± 1.4 sessions/patient). The mean time between the PEA and the first BPA session was 28.1 ± 25.8 months. All patients underwent a comprehensive diagnostic work-up, including right heart catheterization, functional and laboratory tests, before, and 6-4 weeks after the BPA sessions.
After BPA, the mean pulmonary arterial pressure decreased from 44.7 ± 6.4 to 30.8 ± 7.5 mm Hg (31% decline; p < 0.001). Pulmonary vascular resistance decreased from 551.9 ± 185.2 to 343.8 ± 123.8 dyn∗s/cm (38% decline; p < 0.001). The 6-min walking distance increased from 383 ± 104 to 476 ± 107 m (mean change +93 m; p < 0.001). In two sessions (2.8%), serious periprocedural complications occurred. During a mean follow-up of 18 ± 14.3 months, one patient died two months after the last BPA session. Fourteen patients survived.
BPA could be a promising therapeutic strategy for persistent pulmonary hypertension after PEA in patients with CTEPH.
肺动脉内膜剥脱术（PEA）是治疗慢性血栓栓塞性肺动脉高压（CTEPH）的首选方法。然而，PEA 后仍有 5-35%的患者持续存在肺动脉高压。最近，球囊肺动脉成形术（BPA）作为非手术治疗 CTEPH 的策略显示出希望。因此，我们研究了 BPA 在 PEA 后残余肺动脉高压中的应用价值。
15 例 PEA 后存在残余肺动脉高压的患者接受了 71 次 BPA 治疗（4.7±1.4 次/例）。PEA 与首次 BPA 治疗之间的平均时间为 28.1±25.8 个月。所有患者均在 BPA 治疗前后（6-4 周）进行了全面的诊断评估，包括右心导管检查、功能和实验室检查。
BPA 后，平均肺动脉压从 44.7±6.4 降至 30.8±7.5mmHg（下降 31%；p<0.001）。肺血管阻力从 551.9±185.2 降至 343.8±123.8dyn∗s/cm（下降 38%；p<0.001）。6 分钟步行距离从 383±104 增加到 476±107m（平均增加 93m；p<0.001）。在 2 次（2.8%）治疗中出现了严重的围手术期并发症。在平均 18±14.3 个月的随访期间，1 例患者在最后 1 次 BPA 治疗后 2 个月死亡。14 例患者存活。
BPA 可能是 CTEPH 患者 PEA 后持续性肺动脉高压的一种有前途的治疗策略。
