scholarly journals Chronic Thromboembolic Pulmonary Hypertension: A Comprehensive Review and Multidisciplinary Approach to Surgical Treatment

2021 ◽  
Vol 17 (2) ◽  
pp. e18-e28
Author(s):  
Qasim Al Abri ◽  
Alexander Lu ◽  
Mahesh Ramchandani
Keyword(s):  
Pulmonary Hypertension ◽  
Multidisciplinary Approach ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Team Approach ◽  
Pulmonary Thromboendarterectomy ◽  
Comprehensive Review ◽  
Introductory Overview ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed and undertreated sequelae of acute pulmonary embolism. In this comprehensive review, we provide an introductory overview of CTEPH, highlight recent advances in its diagnostic imaging, and describe the surgical technique for pulmonary thromboendarterectomy (PTE), the only established curative treatment for CTEPH. We also discuss the emerging role of balloon pulmonary angioplasty, both independently and combined with PTE, for patients with inoperable, residual, or refractory pulmonary hypertension post PTE. Finally, we stress the importance of a specialized multidisciplinary team approach to CTEPH patient care and share our approach to optimizing care for these patients.

scholarly journals Balloon Pulmonary Angioplasty: State of the Art

2021 ◽  
Vol 16 ◽  
Author(s):  
John G Coghlan ◽  
Alexander MK Rothman ◽  
Stephen P Hoole
Keyword(s):  
Pulmonary Hypertension ◽  
State Of The Art ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Evidence Base ◽  
Novel Technique ◽  
Standard Management ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Chronic Thromboembolic Disease

Balloon pulmonary angioplasty (BPA) is a novel technique for the treatment of chronic thromboembolic pulmonary hypertension. While cardiologists need no introduction to the concept of balloon angioplasty, BPA has its own particular challenges. This article aims to provide the reader with an overview of BPA, starting with an introduction to chronic thromboembolic disease (CTED), the standard management of chronic thromboembolic pulmonary hypertension (CTEPH), technical challenges faced when performing BPA and the evidence base supporting its use. The second part of the article will focus on the future of BPA, in particular the areas where research is required to establish an evidence base to justify the role of BPA in CTEPH and CTED treatment.

scholarly journals The Evolving Role of Balloon Pulmonary Angioplasty in the Management of Chronic Thromboembolic Pulmonary Hypertension

2020 ◽  
Vol 19 (1) ◽  
pp. 21-24
Author(s):  
Takeshi Ogo
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Interventional Treatment ◽  
Clinical Effects ◽  
Beneficial Effects ◽  
Acceptable Risks ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Long Term Prognosis

Patients with chronic thromboembolic pulmonary hypertension (CTEPH), characterized by pulmonary artery obstruction with unresolved embolism, have poor prognosis. Although pulmonary endarterectomy is the treatment of choice in the management of CTEPH, some patients are not operable. Balloon pulmonary angioplasty (BPA) is a catheter-based interventional treatment for patients with CTEPH. BPA has been considered a high-risk procedure, although the beneficial effects were promising. BPA has been modified and refined over the last 10 years. Recent evidence about modern BPA has consistently demonstrated the beneficial clinical effects with acceptable risks. BPA is now recommended in nonoperable CTEPH patients in addition to targeted medical therapy, although several questions such as long-term prognosis remain unanswered. BPA is still evolving for its application in the CTEPH treatment strategy. Further investigations are still necessary to define the role of BPA.

Pulmonary Endarterectomy: Assessment of Operability, Surgical Description, and Post-op Care

2014 ◽  
Vol 12 (4) ◽  
pp. 186-192 ◽  
Author(s):  
David Poch ◽  
Victor Pretorius
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Artery Wedge Pressure ◽  
Pulmonary Endarterectomy ◽  
Pulmonary Thromboendarterectomy ◽  
Thromboembolic Pulmonary Hypertension ◽  
Wedge Pressure

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a mean pulmonary artery pressure ≥25 mm Hg and pulmonary artery wedge pressure ≤15 mm Hg in the presence of occlusive thrombi within the pulmonary arteries. Surgical pulmonary thromboendarterectomy (PTE) is considered the best treatment option for CTEPH.

scholarly journals Soluble ST2 as a Biomarker for Early Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension Treated with Balloon Pulmonary Angioplasty

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 133
Author(s):  
Marta Banaszkiewicz ◽  
Arkadiusz Pietrasik ◽  
Michał Florczyk ◽  
Piotr Kędzierski ◽  
Michał Piłka ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Troponin T ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Early Complications ◽  
Dynamic Changes ◽  
Soluble St2 ◽  
Time Points ◽  
Balloon Pulmonary Angioplasty ◽  
Thromboembolic Pulmonary Hypertension ◽  
Discharge From Hospital

Background: The aim of the study was to assess soluble ST2 (sST2) concentration and its dynamic changes in the periprocedural period in patients with chronic thromboembolic pulmonary hypertension (CTEPH) treated with balloon pulmonary angioplasty (BPA). Methods: We prospectively analyzed 57 procedures of BPA performed in 37 patients with CTEPH. Biomarkers, such as N-terminal pro B-type natriuretic peptide (NT-proBNP), troponin T (TnT), and sST2 were assessed at four time points: Before the BPA procedure, 24 h and 48 h after the procedure, and at the discharge from hospital. Each postprocedural period was assessed for complications. Results: Before the BPA procedure, median sST2 concentration was 26.56 ng/mL (IQR: 16.66–40.83 ng/mL). sST2 concentration was significantly higher 24 h and 48 h after the BPA compared to the baseline measurements (33.31 ng/mL (IQR: 20.81–62.56), p = 0.000 and 27.45 ng/mL (IQR: 17.66–54.45), p = 0.028, respectively). sST2 level 24 h after the BPA procedure was significantly higher in the group with complications compared to the group without complications in the postprocedural period (97.66 ng/mL (IQR: 53.07–126.18) vs. 26.86 ng/mL (IQR: 19.10–40.12), p = 0.000). Conclusions: sST2 concentration in patients with CTEPH treated with BPA changes significantly in the postprocedural period and is significantly higher in the group with complications in postprocedural period.

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