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Balloon Pulmonary Angioplasty in Patients With Thromboembolic Pulmonary Hypertension

  • Panagiotis Karyofyllis
  • Varvara Papadopoulou
  • Vassilis Voudris
  • Hiromi Matsubara
Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
First Online:
Part of the following topical collections:
  1. Topical Collection on Coronary Artery Disease

Abstract

Purpose of review

Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of precapillary pulmonary hypertension. Although pulmonary endarterectomy (PEA) is the preferred management strategy, a significant number of CTEPH patients will have an inoperable disease. As drug therapy is not expected to offer relief from the mechanical component of the disease, the novel technique of balloon pulmonary angioplasty (BPA) has provided a new therapeutic option for patients with inoperable CTEPH. This review will discuss the contemporary use of BPA technique in inoperable CTEPH patients highlighting the effectiveness and safety of this therapeutic option.

Recent findings

Data supporting the role of BPA in inoperable CTEPH are limited to observational studies. However, these observational studies report consistent findings that BPA results in marked improvements in pulmonary hemodynamics and exercise capacity indicating its efficacy and safety as a treatment strategy in inoperable CTEPH patients.

Summary

Summarizing, BPA is an emerging treatment option providing marked improvements in parameters affecting the outcome of CTEPH patients, but multicenter studies are needed to confirm the safety and the long-term efficacy of the procedure, before BPA can be recommended as an established treatment for CTEPH.

Keywords

Chronic thromboembolic pulmonary hypertension Balloon pulmonary angioplasty Pulmonary endarterectomy 
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Notes

Compliance with Ethical Standards

Conflict of Interest

Panagiotis Karyofyllis has received lecture fees from Actelion Pharmaceuticals Hellas, Bayer Hellas, and GlaxoSmithKline.

Varvara Papadopoulou declares no potential conflicts of interest related with this article.

Vassilis Voudris is a section editor for Current Treatment Options in Cardiovascular Medicine.

Hiromi Matsubara has received lecture fees from Actelion Pharmaceuticals Japan, AOP Orphan Pharmaceuticals, Bayer Yakuhin, GlaxoSmithKline, Nippon Shinyaku, and Pfizer Japan, and a research grant from Nippon Shinyaku.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Moser KM, Auger WR, Fedullo PF. Chronic major-vessel thromboembolic pulmonary hypertension. Circulation. 1990;81:1735–43.  https://doi.org/10.1161/01.CIR.81.6.1735.CrossRefPubMedGoogle Scholar
  2. 2.
    Kim NH, Lang IM. Risk factors for chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2012;21:27–31.  https://doi.org/10.1183/09059180.00009111. CrossRefPubMedGoogle Scholar
  3. 3.
    Fedullo P, Kerr KM, Kim NH, Auger WR. Chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2011;183:1605–13.  https://doi.org/10.1164/rccm.201011-1854CI.CrossRefPubMedGoogle Scholar
  4. 4.
    Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Pediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37:67–119.  https://doi.org/10.1093/eurheartj/ehv317.CrossRefPubMedGoogle Scholar
  5. 5.
    Jenkins D, Madani M, Fadel E, D'Armini AM, Mayer E. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017;26:160,111.  https://doi.org/10.1183/16000617.0111-2016.CrossRefGoogle Scholar
  6. 6.
    Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation. 2011;124:1973–81.  https://doi.org/10.1161/CIRCULATIONAHA.110.015008.CrossRefPubMedGoogle Scholar
  7. 7.
    Ghofrani HA, D’Armini AM, Grimminger F, et al. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med. 2013;369:319–29.  https://doi.org/10.1056/NEJMoa1209657.CrossRefPubMedGoogle Scholar
  8. 8.
    Voorburg JA, Cats VM, Buis B, Bruschke AV. Balloon angioplasty in the treatment of pulmonary hypertension caused by pulmonary embolism. Chest. 1988;94(6):1249–53.  https://doi.org/10.1378/chest.94.6.1249.CrossRefPubMedGoogle Scholar
  9. 9.
    Feinstein JA, Goldhaber SZ, Lock JE, et al. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation. 2001;103:10–3.  https://doi.org/10.1161/01.CIR.103.1.10.CrossRefPubMedGoogle Scholar
  10. 10.
    Andreassen AK, Ragnarsson A, Gude E, Geiran O, Andersen R. Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Heart. 2013;99:1415–20.  https://doi.org/10.1136/heartjnl-2012-303,549.CrossRefPubMedGoogle Scholar
  11. 11.
    Kurzyna M, Darocha S, Pietura R, et al. Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience. Kardiologia Polska. 2017;75:645–54.  https://doi.org/10.5603/KP.a2017.0091. CrossRefPubMedGoogle Scholar
  12. 12.
    Velázquez M., Albarran A., Quezada C., et al. Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension: Spanish experience. EuroIntervention, Abstracts EuroPCR 2016, Interv Hypertens StrokeGoogle Scholar
  13. 13.
    Olsson K, Wiedenroth CB, Kamp J-C, et al. Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension: the initial German experience. Eur Respir J. 2017;49:1602409.  https://doi.org/10.1183/13993003.02409-2016.CrossRefPubMedGoogle Scholar
  14. 14.
    Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H. Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv. 2012;5:748–55.  https://doi.org/10.1161/CIRCINTERVENTIONS.112.971077.CrossRefPubMedGoogle Scholar
  15. 15.
    Kimura M, Kohno T, Kawakami T, et al. Midterm effect of balloon pulmonary angioplasty on hemodynamics and subclinical myocardial damage in chronic thromboembolic pulmonary hypertension. Can J Cardiol. 2017;33:463–70.  https://doi.org/10.1016/j.cjca.2016.12.003.CrossRefPubMedGoogle Scholar
  16. 16.
    Inami T, Kataoka M, Shimura N, et al. Pressure-wire-guided percutaneous transluminal pulmonary angioplasty: a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension. JACC: Cardiovasc Interv. 2014;7:1297–306.  https://doi.org/10.1016/j.jcin.2014.06.010.Google Scholar
  17. 17.
    Ogo T, Fukuda T, Tsuji A, et al. Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography. Eur J Radiol. 2017;89:270–6.  https://doi.org/10.1016/j.ejrad.2016.12.013.CrossRefPubMedGoogle Scholar
  18. 18.
    •• Kawakami T, Ogawa A, Miyaji K, et al. Novel angiographic classification of each vascular lesion in chronic thromboembolic pulmonary hypertension based on selective angiogram and results of balloon pulmonary angioplasty. Circ Cardiovasc Interv. 2016;9:e003318.  https://doi.org/10.1161/CIRCINTERVENTIONS.115.003318.A new angiographic classification of each vascular lesion into five types is proposed, as is demonstrated that the outcome and complication rate of BPA are closely related to the location and morphology of the thromboembolic lesion.CrossRefPubMedGoogle Scholar
  19. 19.
    • Aoki T, Sugimura K, Tatebe S, et al. Comprehensive evaluation of the effectiveness and safety of balloon pulmonary angioplasty for inoperable chronic thrombo-embolic pulmonary hypertension: long-term effects and procedure-related complications. Eur Heart J. 2017;00:1–9.  https://doi.org/10.1093/eurheartj/ehx530.This is the first study that comprehensively demonstrates the long-term effects of BPA on hemodynamics, exercise capacity, and prognosis in patients with inoperable CTEPH.Google Scholar
  20. 20.
    •• Ogawa A, Satoh T, Fukuda T, et al. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: results of a multicenter registry. Circ Cardiovasc Qual Outcomes. 2017;10:e004029.  https://doi.org/10.1161/CIRCOUTCOMES.117.004029.This is the first multicenter registry, with a large number of patients and procedures, demonstrated that BPA performed at experienced pulmonary hypertension centers is a safe and effective therapeutic option in patients with CTEPH who are unsuitable for PEA.CrossRefPubMedGoogle Scholar
  21. 21.
    • Taniguchi Y, Miyagawa K, Nakayama K, et al. Balloon pulmonary angioplasty: an additional treatment option to improve the prognosis of patients with chronic thromboembolic pulmonary hypertension. EuroIntervention. 2014;10:518–25.  https://doi.org/10.4244/EIJV10I4A89.This is the first study to describe the efficacy and safety of BPA for patients with non-operable CTEPH using the efficacy and safety achieved by PEA for operable patients as reference.CrossRefPubMedGoogle Scholar
  22. 22.
    Phan K, Jo HE, Xu J, Lau EM. Medical therapy versus balloon angioplasty for CTEPH: a systematic review and meta-analysis. Heart, Lung and Circulation. 2017;  https://doi.org/10.1016/j.hlc.2017.01.016.
  23. 23.
    Lewczuk J, Piszko P, Jagas J, et al. Prognostic factors in medically treated patients with chronic pulmonary embolism. Chest. 2001;119:818–23.  https://doi.org/10.1378/chest.119.3.818.CrossRefPubMedGoogle Scholar
  24. 24.
    Kapitan KS, Buchbinder M, Wagner PD, Moser KM. Mechanisms of hypoxemia in chronic thromboembolic pulmonary hypertension. Am Rev Respir Dis. 1989;139:1149–54.  https://doi.org/10.1164/ajrccm/139.5.1149.CrossRefPubMedGoogle Scholar
  25. 25.
    Ogawa A, Matsubara H. Balloon pulmonary angioplasty: a treatment ooption for inoperable patients with chronic thromboembolic pulmonary hypertension. Front Cardiovasc Med. 2015;2:4.  https://doi.org/10.3389/fcvm.2015.00004.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Yanagisawa R, Kataoka M, Inami T, et al. Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients. Intern J Cardiol. 2014;175:285–9.  https://doi.org/10.1016/j.ijcard.2014.05.011.CrossRefGoogle Scholar
  27. 27.
    • Roik M, Wretowski D, Łabyk A, et al. Refined balloon pulmonary angioplasty-A therapeutic option in very elderly patients with chronic thromboembolic pulmonary hypertension. J Interv Cardiol. 2017;30:249–55.  https://doi.org/10.1111/joic.12387.In this study is demonstrated the safety and efficacy of refined BPA technique in the oldest CTEPH group up to date, placing BPA as an alternative therapeutic strategy in elderly CTEPH patients.CrossRefPubMedGoogle Scholar
  28. 28.
    Nagayoshi S, Ogawa A, Matsubara H. Spontaneous enlargement of pulmonary artery after successful balloon pulmonary angioplasty in a patient with chronic thromboembolic pulmonary hypertension. EuroIntervention. 2016;12:e1435.  https://doi.org/10.4244/EIJ-D-15-00484.CrossRefPubMedGoogle Scholar
  29. 29.
    Inami T, Kataoka M, Shimura N, et al. Pulmonary edema predictive scoring index (PEPSI), a new index to predict risk of reperfusion pulmonary edema and improvement of hemodynamics in percutaneous transluminal pulmonary angioplasty. JACC Cardiovas Interv. 2013;6:725–36.  https://doi.org/10.1016/j.jcin.2013.03.009.CrossRefGoogle Scholar
  30. 30.
    •• Inami T, Kataoka M, Shimura N, Ishiguro H, Yanagisawa R, Kawakami T, et al. Incidence, avoidance, and management of pulmonary artery injuries in percutaneous transluminal pulmonary angioplasty. Int J Cardiol. 2015;201:35–7.  https://doi.org/10.1016/j.ijcard.2015.08.052.This report summarizes the incidence and types of pulmonary artery injuries as procedural complications of BPA, and also summarizes how best to manage these complications.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Panagiotis Karyofyllis
    • 1
  • Varvara Papadopoulou
    • 1
  • Vassilis Voudris
    • 1
  • Hiromi Matsubara
    • 2
  1. 1.Division of Interventional CardiologyOnassis Cardiac Surgery CenterAthensGreece
  2. 2.Department of Clinical Science and Department of CardiologyNational Hospital Organization Okayama Medical CenterOkayamaJapan

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