The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Comparisons of the hemodynamic and functional outcome between these treatments are scarce. In this single‐center observational cohort study, we compared hemodynamics by right heart catheterization and peak oxygen consumption before and 5 months (±14 days) after either PEA or BPA. Comprehensive evaluation and selection for PEA or BPA was performed by an expert CTEPH team. Fourty‐two and fourty consecutive patients were treated with PEA or BPA, respectively. Demographics were similar between groups. Both PEA and BPA significantly reduced mean pulmonary artery pressure (from 46 ± 11 mmHg at baseline to 28 ± 13 mmHg at follow‐up; p < 0.001 and from 43 ± 12 mmHg to 31 ± 9 mmHg; p < 0.001) and pulmonary vascular resistance (from 686 ± 347 dyn s cm −5 at baseline to 281 ± 197 dyn s cm −5 at follow‐up; p < 0.001 and from 544 ± 322 dyn s cm −5 to 338 ± 180 dyn s cm −5 ; p < 0.001), with significantly lower reductions for both parameters in the former group. However, cardiopulmonary exercise testing revealed no significant between group differences in exercise capacity. Diffusion capacity for carbon monoxide at baseline was the only follow‐up predictor for peak VO 2 . In our study, PEA reduced pulmonary pressures more than BPA did, but similar improvements were observed for exercise capacity. Thus, while long term data after BPA is lacking, BPA treated CTEPH patients can expect physical gains in line with PEA.

Purpose: While the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Data comparing improvements in hemodynamics and functional capacity of these treatment modalities are scarce. Methods: In a single center prospective patient cohort, we compared hemodynamics by right heart catheterization and exercise by cardiopulmonary exercise testing (CPET) at admission and 5 months ( §14 days) following treatment. Comprehensive evaluation and selection for PEA or BPA was performed by an expert CTEPH team. Results: With similar patient characteristics and a mean age of 60 years, the two groups consisted of 96 consecutive patients who were treated with PEA (n=42) or BPA (n=54). A mean number of 4.6 [2-11] BPA procedures per patient were performed in the BPA group. Eight patients who were initially treated with PEA later received BPA due to residual pulmonary hypertension. At baseline, no significant between-group differences were observed regarding hemodynamics or exercise capacity. At follow up, PEA reduced mPAP and PVR to significantly lower levels than BPA. However, there were no significant between-group differences regarding improvements in cardiac output, central venous oxygen saturation, or exercise capacity. Conclusion: In our experience, PEA improves pulmonary arterial pressure and pulmonary arterial vascular resistance to significantly lower levels than with BPA. Nevertheless, with similar improvements in cardiac output and mixed venous oxygen saturation, exercise capacity increased to the same extent in both Groups.

BackgroundA leadership development programme (The Health Leadership School) was launched in 2018 for junior doctors and medical students in Norway.ObjectiveTo study participants’ experiences and self-assessed learning outcomes, and if there were any differences in outcome among participants who met face-to-face versus and those who had to complete half of the programme in a virtual classroom due to the COVID-19 pandemic.MethodsParticipants who completed The Health Leadership School in 2018–2020 were invited to respond to a web-based questionnaire.ResultsA total of 33 (83%) out of 40 participants responded. The majority of respondents (97%) somewhat agreed or strongly agreed that they had gained knowledge and skills they did not learn in medical school. Respondents reported a high learning outcome for most competency domains, and there was no difference in outcome when comparing scores of those who met face-to-face versus and those who had to complete half of the programme in a virtual classroom. Among participants who participated in virtual classroom sessions due to the COVID-19 pandemic, the majority agreed that the programme could be run as a combination of face-to-face and virtual sessions.ConclusionThis brief report suggests that leadership development programmes for junior doctors and medical students can be run in-part using virtual classroom sessions, but that face-to-face sessions are important to foster relational and teamwork skills.