30 CTEPH的医学和介入治疗进展

Q2 Medicine Heart Asia Pub Date : 2019-04-01 DOI:10.1136/heartasia-2019-apahff.30
Y. Taniguchi
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The haemodynamic benefits were summarised in a recent review article, with an overall reduction in mean pulmonary arterial pressure of 12–21 mmHg from baseline, and a mortality rate of 0.0%–3.4% after 2–5 angioplasty sessions.4 Sustained haemodynamic improvements, almost to within the normal range, have been reported up to 3.5 years after BPA.5 Severe and fatal complications, including mostly pulmonary vessel injury, may be minimised with not only accumulation of experience but also refinements in technique. An old approach with targeting only one lobe during each session and full balloon sizing increased the incidence of complications. Approaching with undersized balloon may reduce or prevent vessel injury but is less effective in each individual segment, so several segments and lobes are targeted at one session. BPA has the potential to become a key treatment strategy for patients with inoperable CTEPH. However, the indications and limitations of BPA have not been fully established. 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引用次数: 0

摘要

肺动脉内膜切除术是慢性血栓栓塞性肺动脉高压(CTEPH)患者的标准治疗方法,但其中约40%不能手术治疗。一些对照和非对照试验表明,使用肺动脉高压(PAH)特异性药物可能对不能手术的CTEPH有用。2 Riociguat是目前唯一批准用于不能手术的CTEPH的PAH特异性药物。3最近,球囊肺血管成形术(BPA)已成为不能手术的CTEPH或术后持续PH患者的替代治疗选择。现在有几份报告支持BPA的有效性和安全性。最近的一篇综述文章总结了血流动力学方面的益处,平均肺动脉压从基线总体降低了12-21 mmHg, 2-5次血管成形术后的死亡率为0.0%-3.4%持续的血流动力学改善,几乎在正常范围内,已报道bpa后长达3.5年。5严重和致命的并发症,包括大多数肺血管损伤,不仅可以减少经验的积累,也可以减少技术的改进。旧的入路在每次手术中只针对一个肺叶和全球囊尺寸增加了并发症的发生率。使用小球囊可以减少或预防血管损伤,但对每个节段的效果较差,因此一次手术需要针对多个节段和叶。BPA有可能成为无法手术的CTEPH患者的关键治疗策略。然而,双酚a的适应症和局限性尚未完全确定。进一步调查需要由专门中心提供的国际登记册。参考文献Jais X, D 'Armini AM, Jansa P, Torbicki A, Delcroix M, Ghofrani HA, Hoeper MM, Lang IM, Mayer E, Pepke-Zaba J, Perchenet L, Morganti A, Simonneau G, Rubin LJ。波生坦治疗不可手术的慢性血栓栓塞性肺动脉高压:益处(波生坦对不可手术形式的慢性血栓栓塞性肺动脉高压的作用),一项随机、安慰剂对照试验。[J]中国生物医学工程学报,2008;22(2):397 - 397。Ghofrani HA, Simonneau G, D 'Armini AM, Fedullo P, Howard LS, Jais X, Jenkins DP, Jing ZC, Madani MM, Martin N, Mayer E, Papadakis K, Richard D, Kim NH。马西坦用于治疗不能手术的慢性血栓栓塞性肺动脉高压(MERIT-1):来自多中心、随机、双盲、安慰剂对照研究的结果。柳叶刀呼吸医学2017;5:785-794。Ghofrani HA, D 'Armini AM, Grimminger F, Hoeper MM, Jansa P, Kim NH, Mayer E, Simonneau G, Wilkins MR, Fritsch A, Neuser D, Weimann G, Wang C. Riociguat治疗慢性血栓栓塞性肺动脉高压。中华医学杂志,2013;39(3):319 - 329。李晓明,李晓明,李晓明,李晓明,杨志泽,李晓明,李晓明。血管内成形术治疗慢性肺动脉高压的临床研究进展。中华心血管病杂志,2016;14:10 9 - 10。李建军,李建军,李建军,李建军,李建军,李建军,李建军,李建军,李建军。发行量2016;134:2030 - 2032。
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30 Advances in medical and interventional treatments for CTEPH
Pulmonary endarterectomy is the standard care for patients with chronic thromboembolic pulmonary hypertension (CTEPH), however, about 40% of them are inoperable. Several controlled and uncontrolled trials have shown that the use of pulmonary arterial hypertension (PAH)-specific drugs might be useful in inoperable CTEPH.1 2 Riociguat is currently the only PAH-specific drug also approved for inoperable CTEPH.3 Recently, balloon pulmonary angioplasty (BPA) has emerged as an alternative treatment option for patients with inoperable CTEPH or persistent PH after surgery. Several reports now support the efficacy and safety of BPA. The haemodynamic benefits were summarised in a recent review article, with an overall reduction in mean pulmonary arterial pressure of 12–21 mmHg from baseline, and a mortality rate of 0.0%–3.4% after 2–5 angioplasty sessions.4 Sustained haemodynamic improvements, almost to within the normal range, have been reported up to 3.5 years after BPA.5 Severe and fatal complications, including mostly pulmonary vessel injury, may be minimised with not only accumulation of experience but also refinements in technique. An old approach with targeting only one lobe during each session and full balloon sizing increased the incidence of complications. Approaching with undersized balloon may reduce or prevent vessel injury but is less effective in each individual segment, so several segments and lobes are targeted at one session. BPA has the potential to become a key treatment strategy for patients with inoperable CTEPH. However, the indications and limitations of BPA have not been fully established. An international registry contributed by specialised centres is needed for further investigations. References Jais X, D’Armini AM, Jansa P, Torbicki A, Delcroix M, Ghofrani HA, Hoeper MM, Lang IM, Mayer E, Pepke-Zaba J, Perchenet L, Morganti A, Simonneau G, Rubin LJ. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension), a randomized, placebo-controlled trial. J Am Coll Cardiol 2008;52:2127–2134. Ghofrani HA, Simonneau G, D’Armini AM, Fedullo P, Howard LS, Jais X, Jenkins DP, Jing ZC, Madani MM, Martin N, Mayer E, Papadakis K, Richard D, Kim NH. Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicentre, phase 2, randomised, double-blind, placebo-controlled study. Lancet Respir Med 2017;5:785–794. Ghofrani HA, D’Armini AM, Grimminger F, Hoeper MM, Jansa P, Kim NH, Mayer E, Simonneau G, Wilkins MR, Fritsch A, Neuser D, Weimann G, Wang C. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med 2013;369:319–329. Satoh T, Kataoka M, Inami T, Ishiguro H, Yanagisawa R, Shimura N, Shigeta Y, Yoshino H. Endovascular treatment for chronic pulmonary hypertension: a focus on angioplasty for chronic thromboembolic pulmonary hypertension. Expert Rev Cardiovasc Ther 2016;14:1089–1094. Inami T, Kataoka M, Yanagisawa R, Ishiguro H, Shimura N, Fukuda K, Yoshino H, Satoh T. Long-Term Outcomes After Percutaneous Transluminal Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension. Circulation 2016;134:2030–2032.
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Heart Asia
Heart Asia Medicine-Cardiology and Cardiovascular Medicine
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