Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension

Background-Although pulmonary thromboendarterectomy is increasingly success ful for the definitive treatment of chronic thromboembolic pulmonary hypert ension (CTEPH), not all patients have surgically accessible disease. Others are poor surgical candidates because of comorbid illness, Therefore, for s elected patients, we defined and implemented an alternative interventional strategy of balloon pulmonary angioplasty (BPA). Methods and Results-Eighteen patients (mean age, 51.8 years; range, 14 to 7 5 years) with CTEPH underwent BPA; they averaged 2.6 procedures (range, 1 t o 5) and 6 dilations (range, 1 to 12). Selection of pulmonary artery segmen ts for dilation required (1) complete occlusion, () filling defects, or (3) signs of intravascular webs. After an average of 36 months of follow-up (r ange, 0.5 to 66 months), the average New York Heart Association class impro ved from 3.3 to 1.8 (P < 0.001), and 6-minute walking distances increased f rom 209 to 497 yards (P < 0.0001), Pulmonary artery mean pressures decrease d from 43.0 +/- 12.1 to 33.7 +/- 10.2 mm Hg (P = 0.007). Eleven patients de veloped reperfusion pulmonary edema; 3 required mechanical ventilation. Conclusions-BPA reduces pulmonary artery hypertension in patients with CTEP H and is associated with long-term improvement in New York Heart Associatio n class and 6-minute walking distances. BPA is a promising interventional t echnique that warrants randomized comparison with medical therapy in CTEPH patients who are not surgical candidates.