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Background: Pulmonary thromboendarterectomy has been a definitive option for central type of Chronic Thromboembolic Pulmonary Hypertension (CTEPH). However, patients with thromboembolism in the peripheral segments have shown poor prognosis, because such lesions are surgically inaccessible. Therefore, we performed an innovative new approach of balloon pulmonary angioplasty (BPA) for inoperable CTEPH cases and evaluated the efficacy and safety of this treatment.Methods: We performed 54 sessions of BPA for 20 patients who suffered from inoperable peripheral type of CTEPH with mean pulmonary artery pressure (mPAP) ≥ 25mmHg and WHO functional class (WHO-Fc) III or IV in spite of under medical therapy with Bosentan, Sildenafil, or Tadarafil. We evaluated hemodynamic parameters by Swan-Ganz catheter pre oral medical therapy, pre and post BPA. BPA was repeated in 1∼6 sessions to every patient depending on their severity.Results: Medical treatment performed before BPA did not improve hemodynamic parameters (Table). However, BPA dramatically improved hemodynamic parameters such as a significant increase in Cardiac output (CO) and decrease in mPAP and pulmonary vascular resistance (PVR), which are accompanied with improved 6 minutes walk distance and WHO-Fc after BPA therapy. On the other hand, reperfusion pulmonary injury occurred in 27 sessions after BPA with 3 sessions required emergent intubation due to hemorrhagic pulmonary edema. There were no mortal complications.View this table:Table 1Conclusions: BPA could be an effective treatment option for inoperable peripheral type CTEPH to achieve dramatic improvement of hemodynamic and outcome parameters. Further technical modification in attempting to reduce procedural complications will be required.

Efficacy and safety of balloon pulmonary angioplasty for inoperable patients with peripheral type chronic thromboembolic pulmonary hypertension