Balloon Pulmonary Angioplasty: An Effective Treatment for Chronic Thromboembolic Pulmonary Hypertension?

BPA in CTEPH

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a precapillary form of pulmonary hypertension resulting from complications of pulmonary emboli arising from venous thrombosis, leading to pulmonary artery stenosis or obstruction and subsequent right heart failure. Management options for CTEPH include medical therapy, operative therapy, and intervention therapy. In cases where patients are deemed unsuitable candidates for pulmonary endarterectomy (PEA), alternative interventions such as balloon pulmonary angioplasty (BPA) can be considered. To confirm the diagnosis and assess the suitability for BPA, additional examinations including pulmonary angiography, computed tomography pulmonary angiography, magnetic resonance imaging, and right heart catheterization were performed. Current guidelines recommend that BPA should only be conducted in experienced CTEPH expert centers where concurrent medical therapy can be initiated.

Herein, we present a case of a patient who underwent BPA due to the presence of thrombus in the main pulmonary artery and segmental and distal pulmonary arteries, contraindicating PEA. The patient demonstrated significant improvements in clinical outcomes, as evidenced by improved results in the 6-minute walk test, along with echocardiography and computed tomography pulmonary angiography findings post-BPA. Our experience with this patient highlights the potential of BPA as a viable treatment option for inoperable CTEPH patients, resulting in favorable clinical status and improved hemodynamics, with a low mortality rate. This case demonstrates the successful application of BPA in achieving stability and symptom alleviation compared to the pre-procedural state.