Open AccessBalloon pulmonary angioplasty: does it have a role in CTED?
Author(s) -
Coghlan John Gerry
Publication year - 2018
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.1177/2045893218754887
Subject(s) - medicine , angioplasty , pulmonary embolism , cardiology , vascular resistance , hemodynamics , pulmonary hypertension , pulmonary artery , chronic thromboembolic pulmonary hypertension , balloon , natural history , intensive care medicine
In the current issue, Wiedenroth et al. report on the outcome of balloon pulmonary angioplasty (BPA) in ten patients with chronic thromboembolic disease (CTED), but without pulmonary hypertension (PH). Six of the patients presented had completely normal pulmonary artery pressures (PAPs) (< 21mmHg) at rest and five had a pulmonary vascular resistance (PVR)< 3 Wood units (WU), the level above which resistance is considered unequivocally elevated. Despite normal or near normal resting hemodynamics, these patients were highly symptomatic. After an average of nearly four trips to the catheter laboratory, 9/10 reported symptomatic benefit. In addition, favorable trends were reported in hemodynamics, effort tolerance, and biomarkers. The question therefore arises, does this offer hope to the many thousands of patients that remain symptomatic after suffering an acute pulmonary embolism (PE)? To address this question, I shall first outline the current state BPA and its place in our therapeutic armamentarium, then the natural history and consequences of CTED, and finally consider what steps should be taken before we accept BPA as having a role in CTED.