Minatsuki S, et al. Journal of Cardiology. 2020 Feb;75(2):182-188.
Minatsuki S, et al., conducted a study to estimate the potency of Balloon Pulmonary Angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) regardless of having lesions adequate for pulmonary endarterectomy (PEA).
Retrospectively, patients with inoperable CTEPH were investigated and divided into two groups established on the outcomes of pulmonary angiography, computed tomography, and perfusion scintigraphy: (1) BPA-suitable and (2) BPA-unsuitable groups. Patients whose lesions are appropriate for surgical treatment yet did not receive the procedure for any determined purpose were included in the BPA-unsuitable group. The hemodynamic, respiratory, and functional status of the patients before and after BPA was assessed.
Almost 43 patients went through a total of 212 BPA sessions (Table 1). Almost 5 median sessions was done in all patients; the BPA-unsuitable group need extra BPA sessions as compared to the BPA-suitable group (6 vs. 4 sessions, respectively; p < 0.05). With respect to the lesion types, more total occlusion lesions (TOLs) in the BPA- unsuitable group was observed. Lung bleeding (LB) was observed in overall 39 sessions (18%): 26 (18%) in the BPA-suitable group and 13 (19%) in the BPA-unsuitable group (Table 1).
Table 1: Description of balloon pulmonary angioplasties and summary of complications
In all patients, after BPA session, significant improvement was observed in mean pulmonary artery pressure from 43.3 ± 7.8 mmHg to 23.9 ± 4.7 mmHg, pulmonary vascular resistance from 924.1 ± 462.2 dynes/s/cm-5 to 319.7 ± 163.8 dynes/s/cm-5, arterial oxygen saturation level from 89.3 ± 4.3% to 93.4 ± 3.3%; 6- min walking distance from 370.0 ± 107.4 m to 443.8 ± 101.4 m (Table 2).
Table 2: Comparison of hemodynamic status, respiratory function, and functional status between the two groups, before and after treatment
In the BPA-suitable group, 38 mmHg maximum mPAP and 82.3% lowest arterial oxygen saturation level were reported in a single patient with chronic obstructive pulmonary disease who discontinued the treatment after two BPA sessions (Figure 1).
Figure 1: Correlation between the mPAP and SaO2 level; mPAP, mean pulmonary artery pressure; SaO2, arterial oxygen saturation
Thus, BPA safely enhanced the hemodynamic and functional statuses of the patients with CTEPH considered as inoperable for any reason regardless of lesion being adequate for surgical treatment. However, various BPA sessions were needed in these patients.
