title: Combined pulmonary endarterectomy and balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension.
abstract: Pulmonary endarterectomy (PEA) is a curative treatment option for more than 60% of patients with chronic thromboembolic pulmonary hypertension (CTEPH). For selected inoperable patients, interventional balloon pulmonary angioplasty (BPA) has recently been established in addition to medical treatment. This approach disrupts scar tissue occluding the pulmonary arteries, leading to an improvement in parenchymal perfusion. CTEPH is occasionally heterogeneous, with operable disease on one side but peripheral, inoperable changes on the contralateral side. Performing unilateral PEA (on the operable side only) in these patients may lead to a worse hemodynamic outcome and increased mortality compared with patients who that can be surgically corrected bilaterally. We sought to determine the feasibility, safety, and benefits of BPA applied to the contralateral lung in several patients with predominantly unilateral disease that was amenable to treatment by PEA.
  
  
  
  Standard unilateral PEA in deep hypothermic circulatory arrest was performed in 3 CTEPH patients with poor pulmonary hemodynamics, and inoperability of the contralateral pulmonary artery obstructions was confirmed. The inoperable side was treated by BPA. The intervention was performed during the rewarming phase of cardiopulmonary bypass.
  
  
  
  A dramatic improvement in pulmonary hemodynamics, with a mean reduction in pulmonary vascular resistance of 842 dyne · sec/cm(5), was achieved in all patients. World Health Organization Functional Class was also significantly improved at the midterm follow-up.
  
  
  
  The combination of surgical PEA and interventional BPA is a new treatment option for highly selected high-risk CTEPH patients. A multidisciplinary CTEPH expert team is a basic pre-requisite for this complex concept.
authors.affiliation: Department of Thoracic Surgery. Electronic address: c.wiedenroth@kerckhoff-klinik.de.
authors.forename: Christoph B
authors.initials: CB
authors.lastname: Wiedenroth
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Lung Center, DZHK (German Centre for Cardiovascular Research), partner site, Bad Nauheim, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.affiliation: Department of Diagnostic and Interventional Radiology, Justus-Liebig University Giessen, Giessen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Breithecker
authors.affiliation: Department of Thoracic Surgery.
authors.forename: Stefan
authors.initials: S
authors.lastname: Guth
authors.affiliation: Department of Anaesthesiology.
authors.forename: Hans-Jürgen F
authors.initials: HJ
authors.lastname: Lautze
authors.affiliation: Department of Anaesthesiology.
authors.forename: Erik
authors.initials: E
authors.lastname: Ortmann
authors.affiliation: Department of Anaesthesiology.
authors.forename: Matthias
authors.initials: M
authors.lastname: Arlt
authors.affiliation: Department of Diagnostic and Interventional Radiology, Justus-Liebig University Giessen, Giessen, Germany.
authors.forename: Gabriele A
authors.initials: GA
authors.lastname: Krombach
authors.affiliation: Intensive Care Unit, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bandorski
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Lung Center, DZHK (German Centre for Cardiovascular Research), partner site, Bad Nauheim, Germany; Division of Cardiology, Department of Internal Medicine I, Justus-Liebig University Giessen, Giessen, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Lung Center, DZHK (German Centre for Cardiovascular Research), partner site, Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: Department of Thoracic Surgery.
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
mesh_terms: D000800:Angioplasty, Balloon; D002908:Chronic Disease; D004691:Endarterectomy; D006801:Humans; D006976:Hypertension, Pulmonary; D011651:Pulmonary Artery; D011655:Pulmonary Embolism
keywords: balloon pulmonary angioplasty; pulmonary endarterectomy; pulmonary hypertension; thromboembolic; unilateral disease