Functional status and heart failure after balloon pulmonary angioplasty in CTEPH patients – Romanian experience

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is the only form of precapillary pulmonary hypertension (PH) that can be potenti-ally cured using surgical or interventional techniqu-es. Accordingly, to ESC/ERS 2015 guidelines, balloon pulmonary angioplasty (BPA) may be considered for patients who are not candidates for pulmonary endar-terectomy (PEA) or for cases with residual or recurrent PH after PEA. The rationale use of BPA as emerged in-terventional cardiology technique is opening of distal occluded vessels in order to improve pulmonary he-modynamics and, subsequently, clinical and functio-nal status of the patients. First case series of BPA were published in 2001; BPA has evolved in Japan and some western European countries.

Objective: We present first Romanian experience in the field of BPA.

Methods: From a cohort of 6 CTEPH cases, with speci-fic and supportive therapy a number of 2 male patients (64 and 66 y.o, respectively) were selected for BPA. Ca-ses were similar in terms of WHO functional class III, with a six-minute walk distance (6MWD) of 560/495 m and NT-proBNP levels 848.5/1595.5 ng/l. Vascular access was obtained with a 8-Fr sheath through the ri-ght common femoral vein. A 6F Multipurpose guiding catheter was placed straightforward to the inferior lobe of right lung, given the type of lesions and increased blood flow. Lesions (webs, ring like stenosis, subtotal occlusion) were passed by an 0.014” guidewire and se-rial inflations with upsizing PTCA standard balloons were performed. Procedures were successfully, without complications. Regular follow-ups were implemented.

Results: At 6 months after procedure a significant im-provement of non-invasive parameters was recorded: WHO functional class I in both patients, an increase of 6MWD to 630/560 m. Transthoracic echocardiogra-phy performed (Vivid E95, General Electric ultrasound machine) 4 months after BPA showed an improvement of right ventricle metrics and function (ejection frac-tion, global longitudinal strain and tricuspid annular plane systolic excursion). Assessment of NT-proBNP as a prognostic marker in PH patients identified a de-crease to 303.1 ng/l, 104.8 ng/l, respectively.

Conclusions: Limited by the very small number of patients, our results confirm the feasibility of BPA in treatment of well-selected CTEPH patients. In combi-nation with specific therapy with stimulator of soluble guanylate cyclase (Riociguat) and supportive measu-res, BPA improves exercise capacity in CTEPH patients with significant distal disease.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)