Safety and efficacy of balloon pulmonary angioplasty in the treatment of chronic thromboembolic pulmonary hypertension

Objective To evaluate the safety and efficacy of balloon pulmonary angioplasty (BPA) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Methods A study was conducted on 25 patients consisting of 10 males and 15 females with CTEPH who received BPA treatment from February 2017 to May 2018 in Beijing Chaoyang Hospital, Capital Medical University. The changes of brain natriuretic peptide (BNP), mean pulmonary artery pressure (mPAP), tricuspid annulus systolic plane excursion (TAPSE), six-minute walking test (6WMD), right ventricular basement diameter and WHO cardiac function grading were compared before and after treatment with BPA using paired t test. Results Twenty-five patients received a total of 50 BPA treatments, and among them, 12 patients received two or more times. The mPAP decreased from (50.4±9.9) mmHg (1 mmHg=0.133 kPa) to (39.9±10.6) mmHg before and after operation, and the difference was statistically significant (t=9.7, P<0.001); BNP decreased from (513.5±357.3) pg/ml to (106.3±137.53) pg/ml, and the difference was significant (t=3.2, P=0.006); TAPSE increased from (16.2±2.8) mm to (18.0±2.4) mm, and the difference was statistically significant (t=-5.7, P=0.002); the right ventricular base diameter decreased from (45.9±6.9) mm to (41.2±7.3) mm, and the difference was statistically significant (t=5.6, P<0.001); 6WMD increased from (371.1±86.8) m to (467.7±76.1) m, with statistical significance (t=-6.4, P<0.001); WHO cardiac function grading was improved from (2.4±0.7) to (1.2±0.4) after surgery, and the difference was statistically significant (t=2.8, P=0.021). Pulmonary artery injury occurred in 3 patients and 2 patients had hemoptysis.The hemoptysis was stopped after arterial embolization. No other complications such as pulmonary edema occurred. Conclusion BPA may improve clinical status and hemodynamics of patients with CTEPH, which offers an alternative approach of treatment in patients with inoperable CTEPH. Key words: Pulmonary embolism; Chronic disease; Hypertension, pulmonary; Angioplasty, balloon; Treatment outcome