Abstract 13752: Percutaneous Transluminal Pulmonary Angioplasty Markedly Improves Pulmonary Hemodynamics and Long-Term Prognosis of Patients with Distal-Type Chronic Thromboembolic Pulmonary Hypertension
Background: Pulmonary thromboendoarterectomy is not feasible for distal-type chronic thromboembolic pulmonary hypertension (d-CTEPH), which still remains a serious condition with poor prognosis due to the lack of effective treatment. Optical coherence tomography (OCT) is an interferometer-based imaging modality with a high resolution of approximately 10-20 μ m. In the present study, in order to develop an effective and safe treatment for distal-type CTEPH, we examined the effectiveness of our modified methods of percutaneous transluminal pulmonary angioplasty (PTPA) combined with OCT evaluation.
Methods:From July 2009 to May 2012, we prospectively enrolled 22 consecutive patients with distal-type CTEPH, including 2 patients of post-thromboendoarterectomy with residual PH (55±17 [SD] yrs, 20 females and 2 male, WHO-functional class (WHO-FC) II in 6, III in 11 and IV in 5). After stabilizing their condition using conventional pulmonary vasodilators, we carefully performed PTPA in a step-wise manner at an interval of 4-8 weeks.
Results: The conventional pulmonary vasodilator therapy significantly improved cardiac index (CI; 2.32±0.54 to 2.72±0.7 L/min/m2, P<0.05) and plasma levels of brain natriuretic peptide (BNP; 251±327 to 71±101 pg/dl, P<0.05), but did not decrease PAP. Then, we performed PTPA in a step-wise manner (4.4±2.2 procedures for 12±7.7 lesions), which resulted in significant additional improvement of mean PAP (40.4±9.7 to 27.5±8.2 mmHg, P<0.0001) and PVR (610±225 to 346±139 dyn*sec*cm-5, P<0.0001). OCT examination revealed that PTPA destroyed the typical flaps and webs in PA and shifted them to the pulmonary artery walls. The complication of PTPA was mild to moderate hemoptysis in 9 out of the 22 patients, which was successfully managed with non-invasive positive pressure ventilation. Importantly, epoprostenol therapy was successfully terminated in all 8 patients and no patient died during the mean follow-up periods of 15 months, resulting in the significant improvement of prognosis compared with the historical controls (n=38) (P<0.05).
Conclusion: PTPA combined with conventional vasodilator treatment markedly ameliorates pulmonary hemodynamics and long-term prognosis of patients with d-CTEPH.
- © 2012 by American Heart Association, Inc.