Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

被引:142
|
作者
Lang, Irene [1 ]
Meyer, Bernhard C. [2 ]
Ogo, Takeshi [3 ]
Matsubara, Hiromi [4 ]
Kurzyna, Marcin [5 ]
Ghofrani, Hossein-Ardeschir [6 ,7 ,8 ]
Mayer, Eckhard [9 ]
Brenot, Philippe [10 ]
机构
[1] Med Univ Vienna, Div Cardiol, Dept Internal Med 2, Vienna, Austria
[2] Hannover Med Sch, Dept Diagnost & Intervent Radiol, Hannover, Germany
[3] Natl Cerebral & Cardiovasc Ctr, Dept Adv Med Pulm Hypertens, Div Pulm Circulat, Suita, Osaka, Japan
[4] Okayama Med Ctr, Dept Clin Sci, Natl Hosp Org, Okayama, Japan
[5] European Hlth Ctr Otwock, Dept Pulm Circulat & Thromboembol Dis, Med Ctr Postgrad Educ, Otwock, Poland
[6] Univ Giessen & Marburg Lung Ctr, Giessen, Germany
[7] German Ctr Lung Res DZL, Giessen, Germany
[8] Imperial Coll London, Dept Med, London, England
[9] Kerckhoff Heart & Lung Ctr, Bad Nauheim, Germany
[10] Hop Marie Lannelongue, Le Plessis Robinson, France
来源
EUROPEAN RESPIRATORY REVIEW | 2017年 / 26卷 / 143期
关键词
SOLUBLE GUANYLATE-CYCLASE; PERCUTANEOUS CORONARY INTERVENTION; RIGHT-VENTRICULAR FUNCTION; COMPUTED-TOMOGRAPHY; INOPERABLE PATIENTS; COVERED STENT; ENDARTERECTOMY; EFFICACY; MANAGEMENT; RIOCIGUAT;
D O I
10.1183/16000617.0119-2016
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.
引用
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页数:15
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