Echocardiographic evidence of right ventricular functional improvement after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Broch, Kaspar; Murbræch, Klaus; Ragnarsson, Àsgrìmur; Gude, Einar; Andersen, Rune; Fiane, Arnt E.; Andreassen, Johanna; Aakhus, Svend; Andreassen, Arne K.

doi:10.1016/j.healun.2015.08.007

Cited by 69 publications

(40 citation statements)

References 23 publications

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“…Similar findings from another centre have demonstrated a positive effect of BPA on clinical and haemodynamic parameters 6 months post-BPA [57]. Improvements in a number of measures of right heart function have also been observed following BPA intervention, suggesting that this procedure contributes to reversal of right ventricular remodelling [60]. Long-term survival after BPA has been reported as 85% after a mean follow-up period of 51 months [59].…”

Section: Balloon Pulmonary Angioplastysupporting

confidence: 65%

“…Outcomes after BPA BPA has been shown to improve symptoms, function and haemodynamic parameters in patients [21,22,[56][57][58][59][60]. Results from one experienced centre have shown an average reduction in PVR of 57% [22], as well as improvements in functional class, exercise capacity and brain natriuretic peptide levels, at 3 months post-BPA [21,22].…”

Section: Balloon Pulmonary Angioplastymentioning

confidence: 99%

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The changing landscape of chronic thromboembolic pulmonary hypertension management

2017

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For patients with chronic thromboembolic pulmonary hypertension (CTEPH), the current standard of care involves surgical removal of fibro-thrombotic obstructions by pulmonary endarterectomy. While this approach has excellent outcomes, significant proportions of patients are not eligible for surgery or suffer from persistent/recurrent pulmonary hypertension after the procedure. The availability of balloon pulmonary angioplasty and the approval of the first medical therapy for use in CTEPH have significantly improved the outlook for patients ineligible for pulmonary endarterectomy. In this comprehensive review, we discuss the latest developments in the rapidly evolving field of CTEPH. These include improvements in imaging modalities and advances in surgical and interventional techniques, which have broadened the range of patients who may benefit from such procedures. The efficacy and safety of targeted medical therapies in CTEPH patients are also discussed, particularly the encouraging data from the recent MERIT-1 trial, which demonstrated the beneficial impact of using macitentan to treat patients with inoperable CTEPH, including those on background therapy. As the treatment options for CTEPH improve, hybrid management involving more than one intervention in the same patient may become a viable option in the near future.

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Section: Balloon Pulmonary Angioplastysupporting

confidence: 65%

Section: Balloon Pulmonary Angioplastymentioning

confidence: 99%

The changing landscape of chronic thromboembolic pulmonary hypertension management

2017

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“…Data comparing outcomes of PEA in operable patients with those of BPA in inoperable patients suggest that the efficacy and safety of the two procedures are similar in their target cohorts [35]. In addition to the improvements in haemodynamics and functional capacity, there is accumulating evidence that BPA leads to improvements in right ventricular function, including volumes, ejection fraction, peak systolic strain, myocardial remodelling and alleviation of dyssynchrony [31,32,[36][37][38].…”

Section: History Evolution and Evidence For Bpamentioning

confidence: 99%

“…In addition, left ventricular function may be improved, although this has been studied less extensively [32,36]. Improvements in mPAP and pulmonary vascular resistance (PVR) after BPA are associated with reductions in high-sensitivity troponin-T levels, suggesting attenuation of myocardial injury [28].…”

Section: History Evolution and Evidence For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.

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“…Because of the high frequency (61%) of reperfusion oedema aggravating respiratory insufficiency and subsequently requiring mechanical ventilation (17%), interest in this method of treatment for subsequent years was minimal and it was not until the experiences of the Japanese centres became known that a real explosion of interest in BPA occurred [23][24][25]. In the following years, the positive impact of BPA on pulmonary haemodynamics [26], echocardiographic parameters of RV overload [27], and biomarker levels [28] was confirmed. Along with the number of performed procedures, safety measures are also improving.…”

Section: Balloon Pulmonary Angioplasty In Chronic Thromboembolic Pulmmentioning

confidence: 99%

Contemporary methods for the treatment of pulmonary embolism — is it prime-time for percutaneous interventions?

Kurzyna¹,

Pietrasik

Opolski

et al. 2017

Kardiol Pol

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Echocardiographic evidence of right ventricular functional improvement after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Cited by 69 publications

References 23 publications

The changing landscape of chronic thromboembolic pulmonary hypertension management

The changing landscape of chronic thromboembolic pulmonary hypertension management

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Contemporary methods for the treatment of pulmonary embolism — is it prime-time for percutaneous interventions?

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