Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension
Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension
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DOI：
10.1161/01.cir.103.1.10
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发表时间：
2001-01
期刊：
影响因子：
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通讯作者：
J. Feinstein;S. Goldhaber;J. Lock;Susan M. Ferndandes;MichaelJ Landzberg
中科院分区：
文献类型：
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作者：
J. Feinstein;S. Goldhaber;J. Lock;Susan M. Ferndandes;MichaelJ Landzberg
背景——尽管肺血栓内膜切除术对于慢性血栓栓塞性肺动脉高压（CTEPH）的根治性治疗越来越成功，但并非所有患者都患有可手术治疗的疾病。其他人则因合并症而不适合接受手术。因此，对于选定的患者，我们定义并实施了球囊肺血管成形术（BPA）的替代介入策略。方法和结果——18 名 CTEPH 患者（平均年龄 51.8 岁；范围 14 至 75 岁）接受了 BPA；他们平均进行 2.6 次手术（范围，1 至 5）和 6 次扩张（范围，1 至 12）。选择用于扩张的肺动脉段需要 (1) 完全闭塞，(2) 充盈缺损，或 (3) 血管内网的迹象。经过平均 36 个月的随访（范围为 0.5 至 66 个月），纽约心脏协会平均等级从 3.3 提高至 1.8（P <0.001），6 分钟步行距离从 209 码增加至 497 码（P <0.0001）。肺动脉平均压从 43.0±12.1 降至 33.7±10.2 mm Hg (P =0.007)。 11 名患者出现再灌注肺水肿； 3.需机械通风。结论——BPA 可降低 CTEPH 患者的肺动脉高压，并与纽约心脏协会等级和 6 分钟步行距离的长期改善相关。 BPA 是一种很有前途的介入技术，值得与不适合手术的 CTEPH 患者的药物治疗进行随机比较。
Background—Although pulmonary thromboendarterectomy is increasingly successful for the definitive treatment of chronic thromboembolic pulmonary hypertension (CTEPH), not all patients have surgically accessible disease. Others are poor surgical candidates because of comorbid illness. Therefore, for selected patients, we defined and implemented an alternative interventional strategy of balloon pulmonary angioplasty (BPA). Methods and Results—Eighteen patients (mean age, 51.8 years; range, 14 to 75 years) with CTEPH underwent BPA; they averaged 2.6 procedures (range, 1 to 5) and 6 dilations (range, 1 to 12). Selection of pulmonary artery segments for dilation required (1) complete occlusion, (2) filling defects, or (3) signs of intravascular webs. After an average of 36 months of follow-up (range, 0.5 to 66 months), the average New York Heart Association class improved from 3.3 to 1.8 (P <0.001), and 6-minute walking distances increased from 209 to 497 yards (P <0.0001). Pulmonary artery mean pressures decreased from 43.0±12.1 to 33.7±10.2 mm Hg (P =0.007). Eleven patients developed reperfusion pulmonary edema; 3 required mechanical ventilation. Conclusions—BPA reduces pulmonary artery hypertension in patients with CTEPH and is associated with long-term improvement in New York Heart Association class and 6-minute walking distances. BPA is a promising interventional technique that warrants randomized comparison with medical therapy in CTEPH patients who are not surgical candidates.