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 t...
Source: Heart Asia - Category: Cardiology Authors: Tags: Keynote Lecture Source Type: research