Yang Jenny Z, Poch David S, Ang Lawrence, Mahmud Ehtisham, Kim Nick H
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine UC San Diego La Jolla California USA.
Department of Medicine, Division of Cardiovascular Medicine UC San Diego La Jolla California USA.
Pulm Circ. 2023 Nov 20;13(4):e12312. doi: 10.1002/pul2.12312. eCollection 2023 Oct.
Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved pulmonary embolism. The treatment of choice is pulmonary thromboendarterectomy (PTE) surgery and all patients should be evaluated for operability candidacy. Despite advancements in PTE technique allowing more segmental-subsegmental surgeries, up to a third of patients with CTEPH may still be considered inoperable. Over the past decade, there have been increasing treatment options for these inoperable CTEPH patients. Balloon pulmonary angioplasty (BPA) is a percutaneous-based interventional treatment option for select CTEPH cases. Early BPA experiences were plagued by high complication rates, but further refinements in technique and equipment pioneered by Japan led to the worldwide spread and adoption of BPA. Multiple centers have shown that patients experience significant improvements in hemodynamics, quality of life, exercise capacity, and survival with BPA treatment. There remain many questions on best practices, but BPA has evolved into a pivotal cornerstone of CTEPH treatment.
慢性血栓栓塞性肺动脉高压（CTEPH）是由不完全溶解的肺栓塞导致的肺动脉持续性机化血栓栓塞性阻塞引起的。首选治疗方法是肺动脉血栓内膜剥脱术（PTE），所有患者都应评估手术候选资格。尽管PTE技术有所进步，允许进行更多的节段性-亚节段性手术，但仍有多达三分之一的CTEPH患者可能被认为无法进行手术。在过去十年中，对于这些无法进行手术的CTEPH患者，治疗选择越来越多。球囊肺血管成形术（BPA）是一种针对特定CTEPH病例的经皮介入治疗选择。早期的BPA经验受到高并发症发生率的困扰，但日本率先在技术和设备方面进行的进一步改进，使得BPA在全球范围内得到推广和应用。多个中心表明，接受BPA治疗的患者在血流动力学、生活质量、运动能力和生存率方面都有显著改善。关于最佳实践仍有许多问题，但BPA已发展成为CTEPH治疗的关键基石。
