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BACKGROUND: Percutaneous transluminal pulmonary angioplasty (PTPA) can significantly improve the haemodynamics and prognosis of patients with Takayasu arteritis and pulmonary artery involvement. However, the choice of PTPA is mainly based on clinical experience. We aim to classify pulmonary artery lesions in Takayasu arteritis according to pulmonary angiogram and evaluate the PTPA success rate and technical difficulty of different types of lesions. METHODS: We enrolled consecutive patients diagnosed with Takayasu arteritis and pulmonary artery involvement. Patients who underwent pulmonary angiography were included. RESULTS: A total of 365 pulmonary vascular lesions were observed in 63 patients based on pulmonary angiography. According to morphology, distal blood flow of the lesions and PTPA treatment success rate, we classified the pulmonary arterial lesions into 4 groups: type A, stenosis; type B, dilation; type C, subtotal occlusion; type D, total occlusion. Total occlusion was further subclassified as D1, cone-shape occlusion; D2, pocket-like occlusion; and D3, ostium occlusion. The success rate of PTPA was higher in stenosis and subtotal occlusion, whereas ostium occlusion had the lowest success rate. The 2-year survival rate was 97.3% in patients who underwent PTPA. CONCLUSIONS: The morphology of pulmonary lesions in Takayasu arteritis had a significant impact on the PTPA success rate. The failure rate and technical difficulty of PTPA increased in the following order: stenosis, dilation, subtotal occlusion, and total occlusion. Our classification scheme could guide the performance of PTPA for pulmonary artery lesions in Takayasu arteritis.
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BACKGROUND: The efficacy and safety of percutaneous transluminal pulmonary angioplasty (PTPA) for Takayasu arteritis-associated pulmonary hypertension (TA-PH) remain unclear. OBJECTIVES: To examine the efficacy and safety of PTPA in TA-PH. METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials Library were searched from inception to August 18, 2022, for articles investigating the efficacy and safety of PTPA for TA-PH. The primary efficacy outcomes were pulmonary vascular resistance (PVR) changes from baseline to re-evaluation and 6-minute walking distance (6MWD). The safety outcome was procedure-related complications. RESULTS: Five articles comprising 104 patients with TA-PH who underwent PTPA were included. The scores of article quality, as assessed using the methodological index for nonrandomized studies tool, were high, ranging from 13 to 15 points. The pooled treatment effects of PVR (weighted mean difference [WMD]: -4.8 WU; 95% confidence interval [CI]: -6.0 to -3.5 WU; I2 = 0.0%), 6MWD (WMD: 101.9 m; 95% CI: 60.3-143.6 m; I2 = 70.4%) significantly improved. Procedure-related complications, which predominantly present as pulmonary artery injury and pulmonary injury, occurred in 32.0% of the included patients. Periprocedural death occurred in one patient (1.0%, 1/100). CONCLUSIONS: Patients with TA-PH could benefit from PTPA in terms of hemodynamics and exercise tolerance, at the expense of procedure-related complications. PTPA should be encouraged to enhance the treatment response in TA-PH. These findings need to be confirmed by further studies, ideally, randomized controlled trials. REGISTRATION: PROSPERO CRD42022354087.
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Hipertensión Pulmonar , Hipertensión Arterial Pulmonar , Arteritis de Takayasu , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/terapia , Arteritis de Takayasu/diagnóstico , Arteritis de Takayasu/diagnóstico por imagen , Resultado del Tratamiento , Angioplastia/efectos adversos , Hipertensión Arterial Pulmonar/complicacionesRESUMEN
This paper reports that one patient with chronic thromboembolic pulmonary hypertension was significantly improved and close to cure after staged treatment with percutaneous transluminal pulmonary angioplasty on the basis of anticoagulant therapy and pulmonary arterial hypertension-targeted medical therapy.The mean pulmonary artery pressure decreased from 51 mmHg to 20 mmHg.The World Health Organization(WHO)functional class improved from Ⅲ to Ⅰ.This case provides a reference for the treatment of chronic thromboembolic pulmonary hypertension in clinical practice.
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BACKGROUND: Percutaneous transluminal pulmonary angioplasty (PTPA) is a treatment modality for chronic thromboembolic pulmonary hypertension, but whether it can be applied to Takayasu arteritis-associated pulmonary hypertension (TA-PH), another chronic obstructive pulmonary vascular disease, remains unclear. OBJECTIVES: This study sought to investigate the efficacy and safety of PTPA for TA-PH. METHODS: Between January 1, 2016, and December 31, 2019, a total of 50 patients with TA-PH who completed the PTPA procedure (the PTPA group) and 21 patients who refused the PTPA procedure (the non-PTPA group) were prospectively enrolled in this cohort study. The primary outcome was all-cause mortality. The safety outcomes included PTPA procedure-related complications. RESULTS: Baseline characteristics and medical therapies were similar between the PTPA group and the non-PTPA group. During a mean follow-up time of 37 ± 14 months, deaths occurred in 3 patients (6.0%) in the PTPA group and 6 patients (28.6%) in the non-PTPA group, contributing to the 3-year survival rate of 93.7% in the PTPA group and 76.2% in the non-PTPA group (P = 0.0096 for log-rank test). The Cox regression model showed that PTPA was associated with a significantly reduced hazard of all-cause mortality in TA-PH patients (HR: 0.18; 95% CI: 0.05-0.73; P = 0.017). No periprocedural death occurred. Severe complications requiring noninvasive positive pressure ventilation occurred in only 1 of 150 total sessions (0.7%). CONCLUSIONS: PTPA tended to be associated with a reduced risk of all-cause mortality with acceptable safety profiles and seemed to be a promising therapeutic option for TA-PH patients.
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Hipertensión Pulmonar , Hipertensión Arterial Pulmonar , Arteritis de Takayasu , Angioplastia/efectos adversos , Angioplastia/métodos , Estudios de Cohortes , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/terapia , Estudios Retrospectivos , Arteritis de Takayasu/complicaciones , Arteritis de Takayasu/diagnóstico , Arteritis de Takayasu/terapia , Resultado del TratamientoRESUMEN
Objective: To investigate the long-term efficacy of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with Takayasu arteritis (TA) and pulmonary artery stenosis and pulmonary hypertension (PH). Methods: Data from 183 lesions from 79 surgeries performed on 32 patients with TA and PH were analyzed. Symptoms, laboratory investigation results, World Health Organization (WHO) functional class, 6-min walk distance (6 MWD), hemodynamic parameters, and prognosis were analyzed at baseline and follow-up. Results: The mean (± SD) age of the 32 patients (28 female, 4 male) was 42.8 ± 11.9 years, and the median follow-up was 49.5 months (interquartile range, 26-71 months). Compared with baseline, changes in total bilirubin, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, 6 MWD, and WHO score functional class demonstrated significant differences (P<0.001). Echocardiography findings, right and left ventricular diameter, tricuspid annular plane systolic excursion, and estimated pulmonary artery systolic pressure were all improved (P=0.016, P<0.001, P<0.001, and P=0.005, respectively). Importantly, repeat right heart catheterization revealed that mean pulmonary artery pressure, pulmonary vascular resistance, and cardiac index also improved significantly at follow-up (P<0.001, P<0.001, and P=0.011, respectively). Pulmonary angiography revealed post-procedure restenosis in 64 (35.0%) lesions underwent PTPA within three to six months. Among three patients who underwent stent implantation, one experienced restenosis. Two patients died during the follow-up period, one from aggravation of right heart failure after lung infection, and the other in a traffic accident. Conclusions: Results of this study indicated that PTPA significantly improved clinical symptoms, exercise tolerance, and hemodynamic parameters in patients with TA pulmonary artery stenosis and PH. More importantly, reperfusion pulmonary edema significantly decreased, and no patient died of PTPA-related complications with guidance from the pressure wire.
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Hipertensión Pulmonar , Estenosis de Arteria Pulmonar , Arteritis de Takayasu , Angioplastia/efectos adversos , Angioplastia/métodos , Preescolar , Constricción Patológica , Femenino , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/terapia , Pulmón , Masculino , Arteria Pulmonar/cirugía , Estenosis de Arteria Pulmonar/diagnóstico por imagen , Estenosis de Arteria Pulmonar/etiología , Estenosis de Arteria Pulmonar/terapia , Arteritis de Takayasu/complicaciones , Arteritis de Takayasu/terapia , Resultado del TratamientoRESUMEN
AIMS: Balloon pulmonary angioplasty (BPA) improves hemodynamics and exercise tolerance in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, its diagnostic and predictive values remain unclear. We investigated the diagnostic and predictive values of BPA by assessing the mechanism of right ventricular (RV) dysfunction. METHODS AND RESULTS: Hemodynamic improvement was maintained over 6 months in 99 patients with CTEPH who underwent BPA. Notably, 57 of 99 patients showed normalization of pulmonary vascular resistance (PVR) after BPA. The RV mid free wall longitudinal strain (RVMFS) was inversely correlated with the 6-min walk distance (r = -.35, P = .01) and serum levels of high-sensitivity cardiac troponin T (hs-cTNT) (r = -.39, P = .004) 6 months post-BPA in the PVR-normalized group. Among all variables analyzed, only the pre-BPA RVMFS was correlated with the post-BPA RVMFS (r = .40, P = .001), and the pre-BPA RVMFS (<-15.8%) was the strongest predictor of post-BPA normalization of RVMFS (area under the curve 0.80, P = .01, sensitivity 89%, and specificity 63%). The immediate post-BPA RVMFS showed worsening over 6 months after the procedure (-25.8% to -21.1%) in patients with high serum hs-cTNT levels (>0.0014 ng/mL). In contrast, we observed an improvement in these values in those with low serum hs-cTNT levels (-23.6% to -24.4%). CONCLUSION: RVMFS of -15.8% may be a useful cutoff value to categorize the refractory and non-refractory stages of disease. Sustained serum hs-cTNT elevation post-BPA indicates subclinical RV myocardial injury, with resultant RVMFS deterioration and poor exercise tolerance.
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Angioplastia de Balón , Hipertensión Pulmonar , Embolia Pulmonar , Disfunción Ventricular Derecha , Enfermedad Crónica , Ventrículos Cardíacos , Humanos , Hipertensión Pulmonar/diagnóstico , Arteria Pulmonar , Embolia Pulmonar/complicaciones , Disfunción Ventricular Derecha/diagnóstico por imagenRESUMEN
In recent years, therapeutic options for patients with chronic thromboembolic pulmonary hypertension (CTEPH) have expanded with the development of catheter-based interventional therapy, namely balloon pulmonary angioplasty (BPA), also called percutaneous transluminal pulmonary angioplasty. For CTEPH patients with technically inoperable disease or with an unfavorable risk-to-benefit ratio for surgical pulmonary endarterectomy, BPA is an important alternative therapeutic strategy. One important treatment goal of BPA should be the relief of pulmonary hypertension. However, the indications for BPA in specialized Japanese centers currently go beyond the sole indication of relieving pulmonary hypertension. BPA is currently limited to specific institutes and experienced operators, which allows better management of its associated complications of reperfusion pulmonary edema and vascular injury using various strategies based on past experiences. This article discusses the latest indications and treatment goals of BPA and the current flow diagram for therapeutic decision-making in CTEPH, and summarizes the factors to be considered when performing BPA, from a Japanese perspective.
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Angioplastia de Balón , Presión Arterial , Hipertensión Pulmonar/terapia , Arteria Pulmonar/fisiopatología , Embolia Pulmonar/terapia , Angioplastia de Balón/efectos adversos , Enfermedad Crónica , Toma de Decisiones Clínicas , Técnicas de Apoyo para la Decisión , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/fisiopatología , Japón , Selección de Paciente , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiología , Embolia Pulmonar/fisiopatología , Factores de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the feasibility of 2D-perfusion angiography (2D-PA) in order to quantify perfusion changes of the lung parenchyma pre- and post-balloon pulmonary angioplasty (BPA). METHODS: Thirty consecutive interventions in 16 patients with 99 treated pulmonary artery segments were included. To quantify changes in pulmonary blood flow using 2D-PA, the acquired digital subtraction angiographies (DSA) pre- and post-BPA were post-processed. A reference ROI in the treated pulmonary artery and a distal target ROI in the lung parenchyma were placed in corresponding areas on DSA pre- and post-BPA. Time to peak (TTP), peak density (PD) and area under the curve (AUC) were assessed. The ratios reference ROI to target ROI (TTPparenchyma/TTPinflow; PDparenchyma/PDinflow; AUCparenchyma/AUCinflow) were calculated. Relative differences of the 2D-PA parameters were correlated to changes in the pulmonary-flow-grade-score. RESULTS: The pulmonary-flow-grade-score improved after BPA (p<0.0001). Likewise, the ratio TTPparenchyma/TTPinflow shortened by 10% (p=0.0002), the PDparenchyma/PDinflow increased by 46% (p<0.0001) and the AUCparenchyma/AUCinflow increased by 36% (p<0.0001). A significant correlation between changes in the pulmonary-flow-grade-score and changes in PDparenchyma/PDinflow (ρ=0.48, p<0.0001) and AUCparenchyma/AUCinflow (ρ=0.31, p=0.0018) was observed. CONCLUSION: Quantification of pulmonary perfusion pre- and post-BPA using 2D-PA is feasible and has the potential to improve monitoring of BPA. KEY POINTS: ⢠Quantification of BPA results by use of 2D-PA is feasible. ⢠2D-PA allows objective assessment of changes in lung parenchymal perfusion. ⢠2D-PA has the potential to optimize BPA.
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Angiografía de Substracción Digital/métodos , Angioplastia de Balón/métodos , Hipertensión Pulmonar , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/complicaciones , Radiografía Intervencional , Adulto , Anciano , Área Bajo la Curva , Estudios de Factibilidad , Femenino , Hemodinámica , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/cirugía , Masculino , Persona de Mediana Edad , Perfusión , Estudios RetrospectivosRESUMEN
INTRODUCTION: Percutaneous transluminal pulmonary angioplasty (PTPA) was introduced for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in the late 20(th) century, and first attempts in collective patients were made in 2001 with beneficial effects but a moderate amount of complications. It was refined around 2010, and has been recently established as an effective and safe treatment. AREAS COVERED: The indication was originally inoperable CTEPH with peripheral lesions, but has now widened to symptomatic or hypoxic patients. The lesion is typically a meshwork-like structure of organized thrombi and is sometimes not seen as a stenosis angiographically, necessitating other means of investigation such as measurement of distal pressure. The technique to treat lesions is the same as for coronary angioplasty except in several ways. Expert commentary: The effects of PTPA are comparable to those of surgical endarterectomy, and the complications of reperfusion pulmonary edema and vascular injury are now controlled by several strategies and based on experience.
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Angioplastia de Balón/métodos , Hipertensión Pulmonar/terapia , Embolia Pulmonar/terapia , Angiografía/métodos , Enfermedad Crónica , Endarterectomía/métodos , Humanos , Hipertensión Pulmonar/fisiopatologíaRESUMEN
PURPOSE: To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA). MATERIAL AND METHODS: Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test). RESULTS: The overall intervention time was approximately 2 h in both groups (p = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy (p = 0.38), while DAP related to DSA was slightly higher in G3D (p = 0.048). Overall, DAP was significantly higher in G3D (p = 0.002). CONCLUSIONS: The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions. KEY POINTS: ⢠BPA guidance by CACT overlay is feasible and safe. ⢠2D3D image fusion for BPA guidance is accurate. ⢠Image fusion can reduce patient radiation dose due to repeated BPA sessions.
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Angioplastia de Balón/métodos , Arteria Pulmonar/diagnóstico por imagen , Radiografía Intervencional/instrumentación , Radiografía Intervencional/métodos , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/métodos , Anciano , Brazo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Angioplastia/efectos adversos , Manejo de la Enfermedad , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/lesiones , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Anciano , Angioplastia/instrumentación , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , RadiografíaAsunto(s)
Angioplastia/métodos , Anticuerpos Anticardiolipina/sangre , Hipertensión Pulmonar/terapia , Embolia Pulmonar/complicaciones , Anciano , Anticuerpos Anticardiolipina/inmunología , Femenino , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/inmunología , Masculino , Persona de Mediana Edad , Embolia Pulmonar/inmunología , Embolia Pulmonar/terapia , Estudios RetrospectivosRESUMEN
Chronic thromboembolic pulmonary hypertension is defined as pulmonary hypertension (PH) caused by single or recurrent pulmonary emboli and is characterized by chronic obstruction of the pulmonary arteries leading to increased vascular resistance and PH. Also, progressive remodeling may occur in occluded and nonoccluded territories. Better understanding of the underlying mechanisms and risk factors could improve diagnosis and allow appropriate interventions. Pulmonary endarterectomy is an established approach and is considered the definitive treatment for chronic PH, resulting from thromboembolic disease. Furthermore, percutaneous transluminal pulmonary angioplasty is technically feasible, especially for those with peripheral-type of the disease. In addition, several agents, including prostanoids, endothelin receptor antagonists and phosphodiesterase type-5 inhibitors, have been tested in selected patients yielding promising results. Several novel agents are under investigation, and extensive research is currently in progress aiming to resolve uncertainties in the understanding and treatment of the disease.
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Angioplastia , Endarterectomía , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/cirugía , Embolia Pulmonar/complicaciones , Embolia Pulmonar/cirugía , Humanos , Hipertensión Pulmonar/fisiopatología , Embolia Pulmonar/fisiopatología , Resultado del TratamientoRESUMEN
Chronic thromboembolic pulmonary hypertension (CTEPH) is a common type of pulmonary hypertension, resulting from fibrotic transformation of pulmonary artery clots causing chronic obstruction of major pulmonary arteries and associated vascular remodeling in more distal vessels. The mainstay of CTEPH treatment is pulmonary endarterectomy (PEA), which has the potential to be curative but is possible in less than two thirds of cases. In inoperable patients and those with residual or recurrent CTEPH, medical therapy has been shown to be beneficial, albeit not curative. Balloon pulmonary angioplasty (BPA) is a percutaneous technique for the relief of chronic thromboembolic lesions, first reported over two decades ago. More recent case series have demonstrated that, as the technique is refined, results are improving. The potential indications for BPA are now expanding beyond inoperable CTEPH patients, with Shimura et al. demonstrating the aggressive nature of residual or recurrent CTEPH, treated successfully by BPA years after PEA. Major challenges lie ahead of BPA before it can take its place alongside PEA and medication in the treatment of CTEPH.
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Angioplastia , Hipertensión Pulmonar/terapia , Embolia Pulmonar/terapia , Angioplastia/tendencias , Enfermedad Crónica , Predicción , Humanos , Hipertensión Pulmonar/etiología , Embolia Pulmonar/complicacionesRESUMEN
BACKGROUND: Pulmonary endarterectomy (PEA) has been the most effective therapy for chronic thromboembolic pulmonary hypertension (CTEPH). However, residual or recurrent pulmonary hypertension often persists after PEA. Recently, catheter-based angioplasty, called percutaneous transluminal pulmonary angioplasty (PTPA) or balloon pulmonary angioplasty, has been developed as a promising strategy for CTEPH. Therefore, the usefulness of PTPA for residual or recurrent pulmonary hypertension after PEA was investigated. METHODS: Thirty-nine patients underwent PEA from January 2000, and a total of 423 consecutive PTPA sessions in 110 patients were performed from January 2009 to May 2014. Of them, 9 patients (23.0% of 39 patients undergoing PEA and 8.2% of 110 patients undergoing PTPA) had undergone previous PEA and additional PTPA. RESULTS: In these 9 patients, pulmonary vascular resistance (PVR) was 15.6 (7.8-18.9) wood units at baseline, and significantly improved after PEA [5.6 (3.5-6.5) wood units] (p<0.05). However, PVR gradually deteriorated before PTPA [8.1 (6.1-12.3) wood units] compared to after PEA, suggesting that these 9 patients had residual or recurrent pulmonary hypertension after PEA. PTPA was performed at 4.1 (2.7-7.9) years after PEA. Follow-up catheterization at 1.9 (1.3-3.3) years after PTPA revealed significant improvement of PVR [4.2 (2.8-4.8) wood units] (p<0.05). CONCLUSIONS: A hybrid approach combining PEA and additional PTPA may be reasonable for patients with both proximal and very distal lesions not easily approachable by PEA. PTPA could be a promising alternative therapeutic strategy for residual or recurrent pulmonary hypertension after PEA.
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Angioplastia de Balón/métodos , Angioplastia/métodos , Endarterectomía/métodos , Hipertensión Pulmonar/cirugía , Adulto , Angiografía/métodos , Angioplastia/efectos adversos , Angioplastia de Balón/efectos adversos , Endarterectomía/efectos adversos , Femenino , Humanos , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Arteria Pulmonar/cirugía , Embolia Pulmonar/cirugía , Recurrencia , Daño por Reperfusión/etiología , Resultado del Tratamiento , Resistencia Vascular/fisiologíaRESUMEN
OBJECTIVES: This study sought to prove the safety and effectiveness of pressure-wire-guided percutaneous transluminal pulmonary angioplasty (PTPA). BACKGROUND: PTPA has been demonstrated to be effective for treatment of chronic thromboembolic pulmonary hypertension. However, a major and occasionally fatal complication after PTPA is reperfusion pulmonary edema. To avoid this, we developed the PEPSI (Pulmonary Edema Predictive Scoring Index). The pressure wire has been used to detect insufficiency of flow in a vessel. METHODS: We included 350 consecutive PTPA sessions in 103 patients with chronic thromboembolic pulmonary hypertension from January 1, 2009 to December 31, 2013. During these 5 years, 140 PTPA sessions were performed without guidance, 65 with guidance of PEPSI alone, and 145 with both PEPSI and pressure-wire guidance. Each PTPA session was finished after achieving PEPSI scores of <35.4 with PEPSI guidance and each target lesion achieving distal mean pulmonary arterial pressure <35 mm Hg with pressure-wire guidance. RESULTS: The occurrence of clinically critical reperfusion pulmonary edema and vessel injuries were lowest in the group using the guidance of both pressure wire and PEPSI (0% and 6.9%, respectively). Furthermore, the group guided by pressure wire and PEPSI accomplished the same hemodynamic improvements with fewer numbers of target lesions treated and sessions performed. CONCLUSIONS: The combined approach using pressure wire and PEPSI produced more efficient clinical results and greatly reduced reperfusion pulmonary edema and vessel complications. This is further evidence that PTPA is an alternative strategy for treating chronic thromboembolic pulmonary hypertension.
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Angioplastia de Balón , Presión Arterial , Cateterismo Cardíaco , Hipertensión Pulmonar/terapia , Arteria Pulmonar/fisiopatología , Embolia Pulmonar/terapia , Adulto , Anciano , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/mortalidad , Enfermedad Crónica , Femenino , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/mortalidad , Hipertensión Pulmonar/fisiopatología , Japón , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Arteria Pulmonar/lesiones , Edema Pulmonar/etiología , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidad , Embolia Pulmonar/fisiopatología , Presión Esfenoidal Pulmonar , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Lesiones del Sistema Vascular/etiologíaRESUMEN
BACKGROUND: Percutaneous transluminal pulmonary angioplasty (PTPA) is a recently developed catheter-based therapy for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the present study was to investigate the safety and efficacy of PTPA in elderly patients with CTEPH. METHODS: In all, 257 PTPA sessions in 70 patients (median age 63 years) were analyzed. Patients were divided into two groups according to age: (i) a younger group (<65 years; n=39); and (ii) an elderly group (≥65 years; n=31). RESULTS: Hemodynamic improvements were comparable between the younger and elderly groups (63.1% vs. 68.2% decrease in pulmonary vascular resistance, respectively; P>0.05). The median length of stay in the intensive care unit after each session (1.0 vs. 1.0 days) and in hospital per session (9.2 vs. 9.4 days) was similar between the two groups (P>0.05 for all). The prevalence of reperfusion pulmonary edema (23.4% vs. 26.3% across all sessions) and other complications, such as contrast dye-induced nephropathy (0% vs. 2.0%), infection (0% vs. 0%), and neurological complications (0% vs. 1.0%), was comparable in the younger vs. elderly groups (P>0.05 for all). One-year all-cause mortality was similar in the younger and elderly groups (0% vs. 3.2%, respectively; P>0.05). CONCLUSIONS: PTPA can be performed safely and effectively, even in elderly patients, and could be considered as an alternative therapeutic strategy for elderly patients who are too fragile for pulmonary endarterectomy (PEA) or who are treated in institutions without highly experienced PEA surgeons.
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Angioplastia/efectos adversos , Angioplastia/métodos , Tiempo de Internación/tendencias , Adulto , Factores de Edad , Anciano , Angioplastia/mortalidad , Femenino , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Factores de Riesgo , Resultado del TratamientoRESUMEN
Since the last World Symposium on Pulmonary Hypertension in 2008, we have witnessed numerous and exciting developments in chronic thromboembolic pulmonary hypertension (CTEPH). Emerging clinical data and advances in technology have led to reinforcing and updated guidance on diagnostic approaches to pulmonary hypertension, guidelines that we hope will lead to better recognition and more timely diagnosis of CTEPH. We have new data on treatment practices across international boundaries as well as long-term outcomes for CTEPH patients treated with or without pulmonary endarterectomy. Furthermore, we have expanded data on alternative treatment options for select CTEPH patients, including data from multiple clinical trials of medical therapy, including 1 recent pivotal trial, and compelling case series of percutaneous pulmonary angioplasty. Lastly, we have garnered more experience, and on a larger international scale, with pulmonary endarterectomy, which is the treatment of choice for operable CTEPH. This report overviews and highlights these important interval developments as deliberated among our task force of CTEPH experts and presented at the 2013 World Symposium on Pulmonary Hypertension in Nice, France.