Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty

Abstract Aims Balloon pulmonary angioplasty (BPA) has recently been developed as a treatment strategy for chronic thromboembolic pulmonary hypertension (CTEPH) but efficacy and technical safety have to be established. We examine the effects of BPA on patients with inoperable disease or residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). Methods and results From 2015 to 2020 we enrolled symptomatic inoperable CTEPH patients and patients with residual PH after PEA. At baseline and 3 months after last BPA session patients underwent clinical evaluation, 6-min walking distance (6MWD), and right heart catheterization. Friedman test with Bonferroni post-hoc pairwise analysis was used. Fifty patients [male 42%, median age 68 (51–74) years, 42 inoperable, and 8 with residual PH after PEA] were treated for a total of 156 sessions (median 2 sessions/patient); during each session we treated 2.3 (2.2–2.7) vessels. Results are shown in the Table. Forty-nine patients were treated with medical therapy before BPA (19 with combination therapy). Five pulmonary artery dissection and two haemoptysis with clinical impairment were documented during the procedures; 37 patients had lung injury (radiographic opacity with/without haemoptysis and/or hypoxaemia), none had renal dysfunction, 7 patients had access site complications. Seven patients died during follow-up (none within 30 days from the procedure) because of sepsis (1), heart failure (1), cancer (2), arrhythmic storm (2), and sudden death in patients with severe coronary atherosclerosis (1). Conclusions BPA is a safe and effective treatment able to improve symptoms and haemodynamic profile. 45 Table 16MWD, six minute walking distanceCI, cardiac index; mPAP, mean pulmonary arterial pressure; PAC, pulmonary arterial compliance; PVR, pulmonary vascular resistance; RAP, right atrial pressure; SvO2, mixed venous oxygen saturation; WHO-FC, World Health Organization functional class.

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Improved Pulmonary Arterial Compliance in Patients with Inoperable Chronic Thromboembolic Pulmonary Hypertension After Balloon Pulmonary Angioplasty

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a6058 ◽

2020 ◽

Author(s):

Q. Jin ◽

Z. Zhao ◽

Q. Luo ◽

T. Yang ◽

Q. Zeng ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Arterial Compliance ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Balloon Pulmonary Angioplasty ◽

Thromboembolic Pulmonary Hypertension ◽

Pulmonary Arterial

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Decreased time constant of the pulmonary circulation in chronic thromboembolic pulmonary hypertension

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00128.2013 ◽

2013 ◽

Vol 305 (2) ◽

pp. H259-H264 ◽

Cited By ~ 45

Author(s):

Robert V. MacKenzie Ross ◽

Mark R. Toshner ◽

Elaine Soon ◽

Robert Naeije ◽

Joanna Pepke-Zaba

Keyword(s):

Pulmonary Hypertension ◽

Time Constant ◽

Pulmonary Circulation ◽

Wave Reflection ◽

Arterial Compliance ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Left Heart Failure ◽

Thromboembolic Pulmonary Hypertension ◽

Pulmonary Arterial ◽

Rc Time Constant

This study analyzed the relationship between pulmonary vascular resistance (PVR) and pulmonary arterial compliance ( Ca) in patients with idiopathic pulmonary arterial hypertension (IPAH) and proximal chronic thromboembolic pulmonary hypertension (CTEPH). It has recently been shown that the time constant of the pulmonary circulation (RC time constant), or PVR × Ca, remains unaltered in various forms and severities of pulmonary hypertension, with the exception of left heart failure. We reasoned that increased wave reflection in proximal CTEPH would be another cause of the decreased RC time constant. We conducted a retrospective analysis of invasive pulmonary hemodynamic measurements in IPAH ( n = 78), proximal CTEPH ( n = 91) before (pre) and after (post) pulmonary endarterectomy (PEA), and distal CTEPH ( n = 53). Proximal CTEPH was defined by a postoperative mean pulmonary artery pressure (PAP) of ≤25 mmHg. Outcome measures were the RC time constant, PVR, Ca, and relationship between systolic and mean PAPs. The RC time constant for pre-PEA CTEPH was 0.49 ± 0.11 s compared with post-PEA-CTEPH (0.37 ± 0.11 s, P < 0.0001), IPAH (0.63 ± 0.14 s, P < 0.001), and distal CTEPH (0.55 ± 0.12 s, P < 0.05). A shorter RC time constant was associated with a disproportionate decrease in systolic PAP with respect to mean PAP. We concluded that the pulmonary RC time constant is decreased in proximal CTEPH compared with IPAH, pre- and post-PEA, which may be explained by increased wave reflection but also, importantly, by persistent structural changes after the removal of proximal obstructions. A reduced RC time constant in CTEPH is in accord with a wider pulse pressure and hence greater right ventricular work for a given mean PAP.

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TCT-91 Efficacy of aggressive balloon pulmonary angioplasty on chronic thromboembolic pulmonary hypertension beyond normalized mean pulmonary arterial pressure

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.09.364 ◽

2016 ◽

Vol 68 (18) ◽

pp. B37

Author(s):

Yuto Shinkura ◽

Kazuhiko Nakayama ◽

Takayoshi Toba ◽

Hachidai Takahashi ◽

Daisuke Terashita ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Arterial Pressure ◽

Pulmonary Arterial Pressure ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Mean Pulmonary Arterial Pressure ◽

Balloon Pulmonary Angioplasty ◽

Thromboembolic Pulmonary Hypertension ◽

Pulmonary Arterial

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Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic disease

Pulmonary Circulation ◽

10.1177/2045893217753122 ◽

2017 ◽

Vol 8 (1) ◽

pp. 204589321775312 ◽

Cited By ~ 17

Author(s):

Christoph B. Wiedenroth ◽

Karen M. Olsson ◽

Stefan Guth ◽

Andreas Breithecker ◽

Moritz Haas ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Arterial Compliance ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Functional Class ◽

Thromboembolic Disease ◽

World Health ◽

Vascular Lesions ◽

Walking Distance ◽

Balloon Pulmonary Angioplasty ◽

Chronic Thromboembolic Disease

Symptomatic patients with residual pulmonary perfusion defects or vascular lesions but no pulmonary hypertension at rest are diagnosed with chronic thromboembolic disease (CTED). Balloon pulmonary angioplasty (BPA) is an emerging treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but data regarding the safety and efficacy of BPA in patients with CTED are lacking. We report a prospective series of ten consecutive patients with CTED who underwent 35 BPA interventions (median of four per patient) at two German institutions. All patients underwent a comprehensive diagnostic workup at baseline and 24 weeks after their last intervention. BPA was safe, with one pulmonary vascular injury and subsequent self-limiting pulmonary bleeding as the only complication (2.9% of the interventions, 10% of the patients). After the procedures, World Health Organization functional class, 6-min walking distance, pulmonary vascular resistance, and pulmonary arterial compliance improved, and NT-proBNP concentrations declined in 9/10 patients. BPA may be a new treatment option for carefully selected patients with CTED. A larger, prospective, international registry is required to confirm these results.

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