Impact of Balloon Pulmonary Angioplasty on Hemodynamics and Clinical Outcomes in Patients with Chronic Thromboembolic Pulmonary Hypertension: the Initial Korean Experience

• Published in: Journal of Korean medical science Vol. 33; no. 4; pp. e24 - 19
• Main Authors: Kwon, Woochan, 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
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.01.2018; 대한의학회
• Subjects: Adult; Aged; Angiography; Angioplasty, Balloon - adverse effects; Asian Continental Ancestry Group; Blood Pressure; Chronic Disease; Echocardiography; Endarterectomy; Female; Hemodynamics - physiology; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnosis; Male; Middle Aged; Original; Pulmonary Artery - physiology; Pulmonary Artery - surgery; Pulmonary Embolism - complications; Pulmonary Embolism - therapy; Reperfusion Injury - etiology; Republic of Korea; Treatment Outcome; 의학일반; Pulmonary Endarterectomy; Balloon Pulmonary Angioplasty; Chronic Thromboembolic Pulmonary Hypertension
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2018.33.e24

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. 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. 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. BPA might be a safe and effective treatment strategy for both inoperable CTEPH patients and patients with residual pulmonary hypertension after PEA.