Patel Nimai, Hyder Syed N, Michaud Erinleigh, Moles Victor, Agarwal Prachi P, Rosenfield Kenneth, Abe Kohtaro, Haft Jonathan, Visovatti Scott H, Cascino Thomas M, Auger William R, Mclaughlin Vallerie V, Aggarwal Vikas
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
J Soc Cardiovasc Angiogr Interv. 2022 Aug 12;1(6):100429. doi: 10.1016/j.jscai.2022.100429. eCollection 2022 Nov-Dec.
Balloon pulmonary angioplasty (BPA) is an evolving treatment modality for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not candidates for pulmonary endarterectomy. Although several imaging modalities currently exist for evaluating CTEPH, their individual use, specifically in the clinical practice of BPA, has not been well described. In this article, we provide a preprocedural, intraprocedural, and postprocedural interventional imaging roadmap for safe and effective BPA performance in routine clinical practice. Preprocedural assessment includes transthoracic echocardiography for right ventricular assessment, ventilation/perfusion scan to identify pulmonary segments with the highest degree of hypoperfusion, cross-sectional chest imaging excluding alternative causes of mismatched defects and providing anatomic and perfusion imaging concurrently, and nonselective invasive pulmonary angiography for risk stratification of individual lesion subtypes. Intraprocedural assessment includes subselective segmental angiography (SSA) for delineating segmental and subsegmental branch anatomy, lesion identification, and vessel sizing. Intravascular ultrasound and optical coherence tomography serve as adjunctive intraprocedural tools for more accurate vessel sizing and lesion characterization when SSA alone is insufficient. Postprocedural considerations include chest radiography to monitor for immediate postprocedure complications and echocardiography for the interval assessment of the right ventricle on longer-term follow-up.
球囊肺血管成形术（BPA）是一种针对无法进行肺动脉内膜剥脱术的慢性血栓栓塞性肺动脉高压（CTEPH）患者不断发展的治疗方式。尽管目前有多种影像学方法可用于评估CTEPH，但它们各自的用途，特别是在BPA临床实践中的用途，尚未得到充分描述。在本文中，我们提供了一份术前、术中和术后的介入性影像学路线图，以在常规临床实践中安全有效地实施BPA。术前评估包括经胸超声心动图用于右心室评估、通气/灌注扫描以识别灌注减低程度最高的肺段、横断面胸部成像以排除不匹配缺损的其他原因并同时提供解剖和灌注成像，以及非选择性有创肺血管造影用于对个体病变亚型进行风险分层。术中评估包括选择性段血管造影（SSA），用于描绘段和亚段分支解剖结构、识别病变和测量血管大小。当单独使用SSA不足时，血管内超声和光学相干断层扫描可作为术中辅助工具，用于更准确地测量血管大小和表征病变。术后注意事项包括胸部X线摄影以监测术后即刻并发症，以及超声心动图用于在长期随访中对右心室进行间隔评估。
