Document Detail


Refined Balloon Pulmonary Angioplasty for Inoperable Patients with Chronic Thromboembolic Pulmonary Hypertension.
MedLine Citation:
PMID:  23192917     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.METHODS AND 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 (28) SESSIONS WERE PERFORMED IN EACH PATIENT, AND THE NUMBER OF VESSELS DILATED PER SESSION WAS 3 (114). THE WORLD HEALTH ORGANIZATION FUNCTIONAL CLASS IMPROVED FROM 3 TO 2 (P0.01), AND MEAN PULMONARY ARTERIAL PRESSURE WAS DECREASED FROM 45.49.6 TO 24.06.4 MM HG (P0.01). ONE PATIENT DIED BECAUSE OF RIGHT HEART FAILURE 28 DAYS AFTER BPA. DURING FOLLOW-UP FOR 2.21.4 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 (24.05.8 MM HG AT 1.00.9 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:
Hiroki Mizoguchi; Aiko Ogawa; Mitsuru Munemasa; Hiroshi Mikouchi; Hiroshi Ito; Hiromi Matsubara
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-27
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Cardiology and Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan; Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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