title: Additional percutaneous transluminal pulmonary angioplasty for residual or recurrent pulmonary hypertension after pulmonary endarterectomy.
abstract: BACKGROUND
  Pulmonary endarterectomy (PEA) has been the most effective therapy for chronic thromboembolic pulmonary hypertension (CTEPH). However, residual or recurrent pulmonary hypertension often persists after PEA. Recently, catheter-based angioplasty, called percutaneous transluminal pulmonary angioplasty (PTPA) or balloon pulmonary angioplasty, has been developed as a promising strategy for CTEPH. Therefore, the usefulness of PTPA for residual or recurrent pulmonary hypertension after PEA was investigated.
  
  
  METHODS
  Thirty-nine patients underwent PEA from January 2000, and a total of 423 consecutive PTPA sessions in 110 patients were performed from January 2009 to May 2014. Of them, 9 patients (23.0% of 39 patients undergoing PEA and 8.2% of 110 patients undergoing PTPA) had undergone previous PEA and additional PTPA.
  
  
  RESULTS
  In these 9 patients, pulmonary vascular resistance (PVR) was 15.6 (7.8-18.9) wood units at baseline, and significantly improved after PEA [5.6 (3.5-6.5) wood units] (p<0.05). However, PVR gradually deteriorated before PTPA [8.1 (6.1-12.3) wood units] compared to after PEA, suggesting that these 9 patients had residual or recurrent pulmonary hypertension after PEA. PTPA was performed at 4.1 (2.7-7.9) years after PEA. Follow-up catheterization at 1.9 (1.3-3.3) years after PTPA revealed significant improvement of PVR [4.2 (2.8-4.8) wood units] (p<0.05).
  
  
  CONCLUSIONS
  A hybrid approach combining PEA and additional PTPA may be reasonable for patients with both proximal and very distal lesions not easily approachable by PEA. PTPA could be a promising alternative therapeutic strategy for residual or recurrent pulmonary hypertension after PEA.
authors: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors: Nobuhiko
authors: N
authors: Shimura
authors: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: m.kataoka09@z5.keio.jp.
authors: Masaharu
authors: M
authors: Kataoka
authors: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors: Takumi
authors: T
authors: Inami
authors: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors: Ryoji
authors: R
authors: Yanagisawa
authors: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors: Haruhisa
authors: H
authors: Ishiguro
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Takashi
authors: T
authors: Kawakami
authors: Department of Cardiovascular Surgery, Fujita Health University, Aichi, Japan.
authors: Yoshiro
authors: Y
authors: Higuchi
authors: Department of Cardiovascular Surgery, Fujita Health University, Aichi, Japan; Department of Cardiovascular Surgery, Daiyukai Hospital, Aichi, Japan.
authors: Motomi
authors: M
authors: Ando
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Keiichi
authors: K
authors: Fukuda
authors: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors: Hideaki
authors: H
authors: Yoshino
authors: Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan. Electronic address: tsatoh@ks.kyorin-u.ac.jp.
authors: Toru
authors: T
authors: Satoh
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D004691:Endarterectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery; D011655:Pulmonary Embolism / Q000601:surgery; D012008:Recurrence; D015427:Reperfusion Injury / Q000209:etiology; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology
keywords: Chronic thromboembolic pulmonary hypertension; Percutaneous transluminal pulmonary angioplasty; Pulmonary endarterectomy; Residual pulmonary hypertension