ABSTRACT
Objective@#To evaluate the cardiac hemodynamics and function before and after balloon pulmonary angioplasty (BPA) treatment in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using echocardiography, and to discuss the clinical value of the treatment.@*Methods@#A total of 36 CTEPH patients with medium-high risk stratification underwent BPA during the period of September 2016 to January 2019 in Beijing Chao-Yang Hospital, Capital Medical University were recruited. The following conventional echocardiographic parameters including right ventricular basal diameter (RVD), left ventricular basal diameter (LVD), right atrial diameter (RAD), left atrial diameter (LAD), main pulmonary artery diameter (DMPA), left ventricular eccentricity index (LVEI), left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) were recorded.Echocardiographic parameters of right ventricular (RV) function including tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tissue Doppler–derived tricuspid lateral annular systolic velocity (S′), RV index of myocardial performance (RIMP) and right ventricular free wall longitudinal strain (GLS) were measured. The patients were divided into 2 groups according to the threshold value of postoperative SPAP of 50 mmHg (group Ⅰ: SPAP ≤ 50 mmHg, group Ⅱ: SPAP>50 mmHg). Changes between each parameter before and after BPA were analyzed.@*Results@#①The frequency of BPA treatment for CTEPH patients ranged from 1 to 6 times. After BPA treatment, SPAP decreased significantly, and the measurements of RV function including TAPSE, RVFAC, RIMP and GLS improved significantly (all P<0.05). ②Patients in group Ⅰ showed significantly better RV function including TAPSE, RVFAC and GLS compared with group Ⅱ before BPA (P<0.05). ③Univariate logistic regression showed that parameters of preoperative RV function TAPSE, RVFAC and GLS had certain effects on the curative effect of interventional surgery.@*Conclusions@#Echocardiography can evaluate the hemodynamics and RV function in CTEPH patients with BPA.After BPA, pulmonary artery pressure decreases and RV function improves to some extent, suggesting that the treatment of BPA has certain clinical application and popularization value.
ABSTRACT
Objective To evaluate the cardiac hemodynamics and function before and after balloon pulmonary angioplasty ( BPA ) treatment in patients with chronic thromboembolic pulmonary hypertension ( CTEPH) using echocardiography ,and to discuss the clinical value of the treatment . Methods A total of 36 CT EPH patients with medium‐high risk stratification underwent BPA during the period of September 2016 to January 2019 in Beijing Chao‐Yang Hospital ,Capital M edical University were recruited . T he following conventional echocardiographic parameters including right ventricular basal diameter ( RVD ) ,left ventricular basal diameter ( LVD) ,right atrial diameter ( RAD) ,left atrial diameter ( LAD) ,main pulmonary artery diameter ( DM PA ) , left ventricular eccentricity index ( LVEI ) , left ventricular ejection fraction ( LVEF) and pulmonary artery systolic pressure ( PASP ) were recorded .Echocardiographic parameters of right ventricular ( RV ) function including tricuspid annular plane systolic excursion ( T APSE ) , right ventricular fractional area change ( RVFAC ) ,tissue Doppler – derived tricuspid lateral annular systolic velocity ( S′) ,RV index of myocardial performance ( RIM P ) and right ventricular free wall longitudinal strain ( GLS) were measured . T he patients were divided into 2 groups according to the threshold value of postoperative SPAP of 50 mmHg (group Ⅰ :SPAP ≤ 50 mmHg ,group Ⅱ :SPAP＞50 mmHg) . Changes between each parameter before and after BPA were analyzed . Results ① T he frequency of BPA treatment for CT EPH patients ranged from 1 to 6 times . After BPA treatment ,SPAP decreased significantly ,and the measurements of RV function including T APSE ,RVFAC ,RIM P and GLS improved significantly ( all P ＜0 .05) . ②Patients in group Ⅰ showed significantly better RV function including T APSE ,RVFAC and GLS compared with group Ⅱ before BPA ( P ＜0 .05) . ③Univariate logistic regression showed that parameters of preoperative RV function T APSE , RVFAC and GLS had certain effects on the curative effect of interventional surgery . Conclusions Echocardiography can evaluate the hemodynamics and RV function in CT EPH patients with BPA .After BPA ,pulmonary artery pressure decreases and RV function improves to some extent ,suggesting that the treatment of BPA has certain clinical application and popularization value .
ABSTRACT
Chronic thromboembolic pulmonary hypertension(CTEPH)is a complication of pulmonary embolism. It is emphasized that the need for a multidisciplinary team involving diagnosis and treatment. The understanding and management of CTEPH have been updated on the 6 th World Symposium on Pulmonary Hypertension(WSPH)in 2018. Key diagnostic steps in early identification and accurate diagnosis are emphasised. An updated treatment algorithm is proposed. Combined with clinical practice, the article will give an interpretation of diagnosis and treatment of CTEPH based on this consensus opinions.
ABSTRACT
BACKGROUND: The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). However, not all patients are eligible for PEA, and some patients experience recurrence of pulmonary hypertension even after PEA. METHODS: Patients who underwent balloon pulmonary angioplasty (BPA) between December 2015 and April 2017 were enrolled from the Samsung Medical Center CTEPH registry. Enrolled patients underwent right heart catheterization, echocardiography, and 6-minute walk distance (6MWD) at baseline, 4 and 24 weeks after their first BPA session. We compared clinical and hemodynamic parameters at the baseline and last BPA session. RESULTS: Fifty-two BPA sessions were performed in 15 patients, six of whom had a history of PEA. BPA resulted in improvements in World Health Organization (WHO) functional class (2.9 ± 0.8 to 1.7 ± 0.6, P = 0.002), 6MWD (387.0 ± 86.4 to 453.4 ± 64.8 m, P = 0.01), tricuspid annular plane systolic excursion (14.1 ± 3.6 to 15.6 ± 4.3 mm, P = 0.03) and hemodynamics, including a decline in mean pulmonary artery pressure (41.1 ± 13.1 to 32.1 ± 9.5 mmHg, P < 0.001) and in pulmonary vascular resistance (607.4 ± 452.3 to 406.7 ± 265.4 dyne.sec.cm−5, P = 0.01) but not in cardiac index (2.94 ± 0.79 to 2.96 ± 0.93 L/min/m2, P = 0.92). Six cases of complications were recorded, including two cases of reperfusion injury. CONCLUSION: BPA might be a safe and effective treatment strategy for both inoperable CTEPH patients and patients with residual pulmonary hypertension after PEA.
Subject(s)
Humans , Angioplasty , Cardiac Catheterization , Cardiac Catheters , Echocardiography , Endarterectomy , Hemodynamics , Hypertension, Pulmonary , Peas , Pulmonary Artery , Recurrence , Reperfusion Injury , Vascular Resistance , World Health OrganizationABSTRACT
La hipertensión pulmonar tromboembólica crónica presenta un tratamiento curativo, siendo la endarterectomía pulmonar (EP) la opción terapéutica establecida. Sin embargo, la angioplastia con balón a arterias pulmonares puede ser considerada una alternativa viable en pacientes inoperables o en aquellos que persisten con hipertensión pulmonar tras una EP. Se reporta a continuación el primer caso de angioplastia con balón a arterias pulmonares realizada en un centro de Argentina.
Chronic thromboembolic pulmonary hypertension presents a curative treatment, with pulmonary endarterectomy being the established therapeutic option. However, balloon angioplasty to pulmonary arteries may be considered an alternative therapeutic option for patients with inoperable or residual disease after surgery. Herewith, we report the first case of chronic thromboembolic pulmonary hypertension treated with balloon pulmonary angioplasty in Argentina.
A hipertensão pulmonar tromboembólica crônica tem um tratamento curativo, a endarterectomia pulmonar (EP), a opção terapêutica estabelecida. No entanto, angioplastia com balão de artérias pulmonares pode ser considerado uma alternativa viável em pacientes inoperáveis ou aqueles que persistem com a hipertensão pulmonar após EP. Relatamos o primeiro caso de angioplastia pulmonar com balão no centro da Argentina.