Balloon Pulmonary Angioplasty Chronic Thromboembolic Pulmonary Hypertension
█ Case report
Balogh László, Szűk Tibor, Daragó Andrea, Péter Andrea, Édes István
Debreceni Egyetem Klinikai Központ, Kardiológiai és Szívsebészeti Központ, Debrecen
Chronic thromboembolic pulmonary hypertension (CTEPH) develops after pulmonary embolism (PE) when resolution of the clot is incomplete resulting in mechanical obstruction, which leads to elevation of the pulmonary pressure. Two factors are responsible for pulmonary hypertension (PH); the first is the mechanical obstruction, the second is the arteriopathy and vascular remodelling due to flow acceleration in non-obstructed vessels. Dyspnea over 3-6 month after PE raises the suspicion of CTEPH, so echocardiography is indicated in such cases. When echocardiography reveals elevated pulmonary pressure, further investigations are required such as ventilation-perfusion lung scintigraphy, Swan-Ganz catheterisation, CT pulmonary angiography (CTPA) and pulmonary angiography (PA). According to the results of the above mentioned examinations it can be decided if pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty is necessary to be performed. The organized thrombus cannot be reached surgically in nearly half of the cases, so BPA is the only therapeutic choice while drug treatment is less effective in CTEPH. Wires and balloons used in routine coronary interventions are used during BPA as well, but stent implantation is not required. The procedure is performed in multiple sessions. A small area is revascularised during one session to avoid reperfusion lung oedema. To best of our knowledge we are the first, who performed such cases in Hungary.