(Circulation. 2001;103:10.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension
From the Boston Adult Congenital Heart Service, Brigham and Women’s and Children’s Hospitals; the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School (S.Z.G., S.M.F., M.J.L.); and the Department of Pediatric Cardiology, Children’s Hospital, Harvard Medical School (J.A.F., J.E.L., S.M.F., M.J.L.), Boston, Mass. Dr Feinstein is now with the Vera Moulton Wall Center for Pulmonary Vascular Disease and the Division of Pediatric Cardiology, Stanford University Medical Center, Palo Alto, Calif.
Correspondence to Michael J. Landzberg, MD, BACH Service, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail Landzber{at}cardio.tch.harvard.edu
Background—Although pulmonary thromboendarterectomy is increasingly successful for the definitive treatment of chronic thromboembolic pulmonary hypertension (CTEPH), not all patients have surgically accessible disease. Others are poor surgical candidates because of comorbid illness. Therefore, for selected patients, we defined and implemented an alternative interventional strategy of balloon pulmonary angioplasty (BPA).
Methods and Results—Eighteen patients (mean age, 51.8 years; range, 14 to 75 years) with CTEPH underwent BPA; they averaged 2.6 procedures (range, 1 to 5) and 6 dilations (range, 1 to 12). Selection of pulmonary artery segments for dilation required (1) complete occlusion, (2) filling defects, or (3) signs of intravascular webs. After an average of 36 months of follow-up (range, 0.5 to 66 months), the average New York Heart Association class improved from 3.3 to 1.8 (P<0.001), and 6-minute walking distances increased from 209 to 497 yards (P<0.0001). Pulmonary artery mean pressures decreased from 43.0±12.1 to 33.7±10.2 mm Hg (P=0.007). Eleven patients developed reperfusion pulmonary edema; 3 required mechanical ventilation.
Conclusions—BPA reduces pulmonary artery hypertension in patients with CTEPH and is associated with long-term improvement in New York Heart Association class and 6-minute walking distances. BPA is a promising interventional technique that warrants randomized comparison with medical therapy in CTEPH patients who are not surgical candidates.
Key Words: balloon • angioplasty • embolism • thrombus • pulmonary heart disease
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