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Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially lethal outcome of pulmonary embolism. Balloon pulmonary angioplasty (BPA) is aimed at improving pulmonary perfusion and pulmonary hemodynamics and has gained a lot of interest recently in patients either unsuitable for or refractory to surgical pulmonary endarterectomy. This article outlines the clinical features and diagnostic criteria, imaging evaluation, current medical and surgical treatment options for CTEPH. BPA is discussed in detail, focusing on the rationale, patient selection, technical details, post-procedural care and outcomes.

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Abbreviations

mPAP:

Mean pulmonary artery pressure

WHO:

World Health Organization

RVP:

Right ventricular pressure

mRAP:

Mean right atrial pressure

CI:

Cardiac index

PVR:

Pulmonary vascular resistance

TPR:

Total pulmonary resistance

6MWD:

Six-minute walking distance

BNP:

B-type natriuretic peptide

NT-proBNP:

N-terminal pro b-type natriuretic peptide

PAI:

Pulmonary artery injury

RPE:

Reperfusion edema

RHF:

Right heart failure

PE:

Pulmonary embolism

NPPV:

Noninvasive positive pressure ventilation

vaECMO:

Venoarterial extracorporeal membrane oxygenation

POD:

Postoperative day

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Correspondence to J. M. Moriarty.

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Moriarty, J.M., Khan, S.N., Kao, S.D. et al. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension. Cardiovasc Intervent Radiol 41, 1826–1839 (2018). https://doi.org/10.1007/s00270-018-2012-2

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Keywords

  • Chronic thromboembolic pulmonary hypertension (CTEPH)
  • Balloon pulmonary angioplasty (BPA)
  • Pulmonary embolism