Abstract 11867: Percutaneous Transluminal Pulmonary Angioplasty Markedly Improves Pulmonary Hemodynamics in Patients with Distal-Type Chronic Thromboembolic Pulmonary Hypertension
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) remains a serious disorder, where pulmonary thromboendarterectomy could improve pulmonary hemodynamics in proximal-type CTEPH; however, effective therapeutic strategy remains to be developed for distal-type CTEPH. In this study, we examined the effects of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with distal-type CTEPH in addition to conventional vasodilator treatment.
Methods: We treated 8 consecutive patients with distal-type CTEPH, including one patient with pulmonary hypertension after thromboendarterectomy (60±15 [SD] yrs, 7 female, 6 treated with epoprostenol, 2 beraprost, 7 sildenafil, and 5 bosentan). We first performed medical vasodilator therapy including iv epoprostenol, followed by staged PTPA (4.6±1.5 procedures/patient) with balloon dilations (mean 13±4/procedure) in the 8 patients over a period of 6∼12 months.
Results: The initial medical therapy with vasodilators significantly improved cardiac index (CI; 2.03±0.28 to 2.56±0.49 L/min/m2, P<0.05) and brain natriuretic peptide levels (BNP; 486±396 to 99±135 pg/dl, P<0.05), but did not decrease pulmonary artery pressure. Importantly, subsequent additional PTPA significantly decreased mean pulmonary artery pressure (46.6±7.5 to 35.3±5.3 mm Hg, P<0.01) and pulmonary vascular resistance (764±188 to 438±108 dyn*sec*cm-5, P<0.01). Consequently, iv epoprostenol was terminated in 7 out of the 8 patients. Hemoptysis occurred in 5 out of 8 patients as a complication.
Conclusion: Our initial experience shows that PTPA combined with conventional vasodilator therapy is quite effective to improve pulmonary hemodynamics in patients with distal-type CTEPH.
- © 2011 by American Heart Association, Inc.