title: Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension.
abstract: BACKGROUND
  Although balloon pulmonary angioplasty (BPA) for inoperable patients with chronic thromboembolic pulmonary hypertension was first reported over a decade ago, its clinical application has been restricted because of limited efficacy and complications. We have refined the procedure of BPA to maximize its clinical efficacy.
  
  
  RESULTS
  Sixty-eight consecutive patients with inoperable chronic thromboembolic pulmonary hypertension underwent BPA. We evaluated pulmonary artery diameters and determined the appropriate balloon size by using intravascular ultrasound. We performed BPA in a staged fashion over multiple, separate procedures to maximize efficacy and reduce the risk of reperfusion pulmonary injury. A total of 4 (2-8) sessions were performed in each patient, and the number of vessels dilated per session was 3 (1-14). The World Health Organization functional class improved from 3 to 2 (P<0.01), and mean pulmonary arterial pressure was decreased from 45.4 ± 9.6 to 24.0 ± 6.4 mm Hg (P<0.01). One patient died because of right heart failure 28 days after BPA. During follow-up for 2.2 ± 1.4 years after the final BPA, another patient died of pneumonia, and the remaining 66 patients are alive. In 57 patients who underwent right heart catheterization at follow-up, improvement of mean pulmonary arterial pressure was maintained (24.0 ± 5.8 mm Hg at 1.0 ± 0.9 years). Forty-one patients (60%) developed reperfusion pulmonary injury after BPA, but mechanical ventilation was required in only 4 patients.
  
  
  CONCLUSIONS
  Our refined BPA procedure improves clinical status and hemodynamics of inoperable patients with chronic thromboembolic pulmonary hypertension, with a low mortality. A refined BPA procedure could be considered as a therapeutic approach for patients with inoperable chronic thromboembolic pulmonary hypertension.
authors.affiliation: Division of Cardiology, National Hospital Organization Okayama Medical Center, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Mizoguchi
authors.forename: Aiko
authors.initials: A
authors.lastname: Ogawa
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munemasa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mikouchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Hiromi
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D002908:Chronic Disease; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000401:mortality; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D020127:Recovery of Function; D015427:Reperfusion Injury / Q000209:etiology / Q000628:therapy; D012121:Respiration, Artificial; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional