Pulmonary balloon angioplasty for patients with chronic thromboembolic pulmonary hypertension accompanying with progressed pulmonary hypertension after pulmonary endarterectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Jiade , JIANG Xin , DENG Long , SONG Wu , HUA Lu , JING Zhicheng ,  LIU Sheng ,  SONG Yunhu

Adult Cardiac Surgery Center, Pulmonary Vascular Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, P.R.China;

Corresponding author：

LIU Sheng, Email: liusheng1999@msn.com; SONG Yunhu, Email: songtiger_fw@foxmail.com

Keywords：

Chronic thromboembolic pulmonary hypertension; pulmonary endarterectomy; sequential pulmonary balloon angioplasty; treatment result

DOI：

10.7507/1007-4848.201810032

Video：

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Objective To describe the effect of sequential pulmonary balloon angioplasty for patients with chronic thromboembolic pulmonary hypertension, who was accompanied with progressed pulmonary hypertension after pulmonary endarterectomy surgeries.Methods From 2014 to December 2017, 7 patients were treated with a combination therapy of pulmonary endarterectomy and sequential pulmonary balloon angioplasty. There were 1 male and 6 females at age of 58 (43–59) years. A follow-up period of more than 1 year was accomplished. The result of right sided heart catheterization and ultrasonic cardiogram between and after the pulmonary endarterectomy or balloon angioplasty was collected.Results Seven patients were treated with a combination of pulmonary endarterectomy and sequential pulmonary balloon angioplasty, which included 1 patient of single pulmonary balloon angioplasty and 6 patients of multiple pulmonary balloon angioplasties. The balloon dilation times was 2 (2–6), and the number of segments during each single balloon dilatation was 3–5, compared with the first clinical results before the first balloon dilation, systolic pulmonary artery pressure [53 (47–75) mm Hg vs. 45 (40–54) mm Hg, P=0.042), mean pulmonaryartery pressure [38 (29–47) mm Hg vs. 29 (25–39) mm Hg, P=0.043], N terminal-B type natriuretic peptide [1 872 (1 598–2 898) pg/ml vs. 164 (72–334) pg/ml, P=0.018] improved significantly after the last balloon angioplasty. Heart function classification (NYHA) of all the 7 patients were recovered to Ⅰ-Ⅱclasses (P<0.05).Conclusion Sequential pulmonary balloon angioplasty after pulmonary endarterectomy can further reduce the patient's right heart after load, improve the heart function for patients with progressed pulmonary hypertension after pulmonary endarterectomy surgeries.

Citation： ZHU Jiade, JIANG Xin, DENG Long, SONG Wu, HUA Lu, JING Zhicheng, LIU Sheng, SONG Yunhu. Pulmonary balloon angioplasty for patients with chronic thromboembolic pulmonary hypertension accompanying with progressed pulmonary hypertension after pulmonary endarterectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 698-703. doi: 10.7507/1007-4848.201810032 Copy

1.	Galie 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 Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
2.	Auger WR, Kim NH, Kerr KM, et al. Chronic thromboembolic pulmonary hypertension. Clin Chest Med, 2007, 28(1): 255-269.
3.	Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation, 2011, 124(18): 1973-1981.
4.	Mehrdad HS, Bruce JK, Ajit R, et al. Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation? insights from pulmonary thromboendarterectomy. J Am Coll Cardiol, 2004, 44(1): 126-132.
5.	Condliffe R, Kiely DG, Gibbs JS, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med, 2008, 177: 1122-1127.
6.	Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thrombo-endarterectomy: Effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg, 2011, 141(2): 383-387.
7.	Ishida K, Masuda M, Tanabe N, et al. Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Thorac Cardiovasc Surg, 2012, 144(2): 321-326.
8.	Feinstein JA, Goldhaber SZ, Lock JE, et al. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation, 2001, 103(1): 10-13.
9.	Andreassen AK, Ragnarsson A, Gude E, et al. Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Heart, 2013, 99(19): 1415-1420.
10.	Yanaka K, Nakayama K, Shinke T, et al. Sequential hybrid therapy with pulmonary endarterectomy and additional balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. J Am Heart Assoc, 2018, 7(13): pii: e008838.
11.	Nobuhiko S, Masaharu K, Takumi I, et al. Additional percutaneous transluminal pulmonary angioplasty for residual or recurrent pulmonary hypertension after pulmonary endarterectomy. Inter J Cardiol, 2015, 183: 138-142.
12.	Skoro-Sajer N, Marta G, Gerges C, et al. Surgical specimens,haemodynamics and long-term outcomes after pulmonary endarterectomy. Thorax, 2014, 69(2): 116-122.
13.	Kunihara T, Gerdts J, Groesdonk H, et al. Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with 279 patients. Eur J Cardiothorac Surg, 2011, 40(1): 154-161.
14.	Inami T, Kataoka H, Ando M, et al. A new era of therapeutic strategies for chronic thromboembolic pulmonary hypertension by two different interventional therapies; pulmonary endarterectomy and percutaneous transluminal pulmonary angioplasty. PLoS One, 2014, 9(4): e94587.
15.	Bonderman D, Skoro-Sajer N, Jakowitsch J, et al. Predictors of outcome in chronic thromboembolic pulmonary hypertension. Circulation, 2007, 115(16): 21532158.
16.	Ryoji Y, Masaharu K, Takumi I, et al. Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients. Intern J Cardiol, 2014, 175(2): 285-289.
17.	Haruhisa I, Masaharu K, Takumi I, et al. Percutaneous transluminal pulmonary angioplasty for central-type chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol Intv, 2013, 6(11): 1012-1013.
18.	Stephane C, Philippe B, Olaf M, et al. Rescue balloon pulmonary angioplasty for early failure of pulmonary endarterectomy: The earlier the better? Int J Cardiol, 2016, 222: 39-40.
19.	Takumi I, Masaharu K, Haruhisa I, et al. Percutaneous transluminal pulmonary angioplasty for chronic thromboembolic pulmonary hypertension with severe right heart failure. Am J Respir Crit Care Med, 2014, 189(11): 1437-1439.
20.	Christoph BW, Christoph L, Andreas B, et al. Combined pulmonary endarterectomy and balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant, 2016, 35(5): 591-596.
21.	Takumi I, Masaharu K, Nobuhiko S, et al. Pressure-wire-guided percutaneous transluminal pulmonary angioplasty a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol Intv, 2014, 7(11): 1297-1306.
22.	Takumi I, Masaharu K, Nobuhiko S, 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. J Am Coll Cardiol Intv, 2013, 6(7): 725-736.

1. Galie 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 Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
2. Auger WR, Kim NH, Kerr KM, et al. Chronic thromboembolic pulmonary hypertension. Clin Chest Med, 2007, 28(1): 255-269.
3. Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation, 2011, 124(18): 1973-1981.
4. Mehrdad HS, Bruce JK, Ajit R, et al. Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation? insights from pulmonary thromboendarterectomy. J Am Coll Cardiol, 2004, 44(1): 126-132.
5. Condliffe R, Kiely DG, Gibbs JS, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med, 2008, 177: 1122-1127.
6. Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thrombo-endarterectomy: Effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg, 2011, 141(2): 383-387.
7. Ishida K, Masuda M, Tanabe N, et al. Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Thorac Cardiovasc Surg, 2012, 144(2): 321-326.
8. Feinstein JA, Goldhaber SZ, Lock JE, et al. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation, 2001, 103(1): 10-13.
9. Andreassen AK, Ragnarsson A, Gude E, et al. Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension. Heart, 2013, 99(19): 1415-1420.
10. Yanaka K, Nakayama K, Shinke T, et al. Sequential hybrid therapy with pulmonary endarterectomy and additional balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. J Am Heart Assoc, 2018, 7(13): pii: e008838.
11. Nobuhiko S, Masaharu K, Takumi I, et al. Additional percutaneous transluminal pulmonary angioplasty for residual or recurrent pulmonary hypertension after pulmonary endarterectomy. Inter J Cardiol, 2015, 183: 138-142.
12. Skoro-Sajer N, Marta G, Gerges C, et al. Surgical specimens,haemodynamics and long-term outcomes after pulmonary endarterectomy. Thorax, 2014, 69(2): 116-122.
13. Kunihara T, Gerdts J, Groesdonk H, et al. Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with 279 patients. Eur J Cardiothorac Surg, 2011, 40(1): 154-161.
14. Inami T, Kataoka H, Ando M, et al. A new era of therapeutic strategies for chronic thromboembolic pulmonary hypertension by two different interventional therapies; pulmonary endarterectomy and percutaneous transluminal pulmonary angioplasty. PLoS One, 2014, 9(4): e94587.
15. Bonderman D, Skoro-Sajer N, Jakowitsch J, et al. Predictors of outcome in chronic thromboembolic pulmonary hypertension. Circulation, 2007, 115(16): 21532158.
16. Ryoji Y, Masaharu K, Takumi I, et al. Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients. Intern J Cardiol, 2014, 175(2): 285-289.
17. Haruhisa I, Masaharu K, Takumi I, et al. Percutaneous transluminal pulmonary angioplasty for central-type chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol Intv, 2013, 6(11): 1012-1013.
18. Stephane C, Philippe B, Olaf M, et al. Rescue balloon pulmonary angioplasty for early failure of pulmonary endarterectomy: The earlier the better? Int J Cardiol, 2016, 222: 39-40.
19. Takumi I, Masaharu K, Haruhisa I, et al. Percutaneous transluminal pulmonary angioplasty for chronic thromboembolic pulmonary hypertension with severe right heart failure. Am J Respir Crit Care Med, 2014, 189(11): 1437-1439.
20. Christoph BW, Christoph L, Andreas B, et al. Combined pulmonary endarterectomy and balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant, 2016, 35(5): 591-596.
21. Takumi I, Masaharu K, Nobuhiko S, et al. Pressure-wire-guided percutaneous transluminal pulmonary angioplasty a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol Intv, 2014, 7(11): 1297-1306.
22. Takumi I, Masaharu K, Nobuhiko S, 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. J Am Coll Cardiol Intv, 2013, 6(7): 725-736.

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Pulmonary balloon angioplasty for patients with chronic thromboembolic pulmonary hypertension accompanying with progressed pulmonary hypertension after pulmonary endarterectomy

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