Abstract
Background
Lung injury is a serious complication of balloon pulmonary angioplasty (BPA) for chronic
thromboembolic pulmonary hypertension (CTEPH). Selecting a smaller balloon might minimize
the occurrence of lung injury; however, it could also increase the risk of restenosis.
Methods
We analyzed the first target lesions in the initial BPA procedure in 34 consecutive
patients with CTEPH. We measured proximal pressure with a guiding catheter and distal
pressure with a pressure wire. We retrospectively investigated pressure gradients
at the lesions before and immediately after the initial dilation with a smaller balloon
and before the second procedure.
Results
The proximal pressure decreased, and the distal pressure increased immediately after
the initial balloon dilation. The pressure gradient at the lesion diminished significantly
by the second procedure (from 26.4 ± 10.7 to 18.2 ± 9.9 mm Hg, P < 0.001) without serious complications. The residual pressure gradient had further
diminished (to 9.8 ± 6.5 mm Hg, P = 0.02) until the second procedure. The reduction in pressure gradient at the lesion
from immediately after the initial balloon dilation to the second procedure was positively
correlated with both the baseline mean pulmonary arterial pressure (r2 = 0.23, P = 0.004) and residual pressure gradient immediately after the initial balloon dilation
(r2 = 0.58, P < 0.001).
Conclusions
The residual pressure gradient at the lesion diminished continually after dilation
with a smaller balloon. This strategy could decrease pulmonary arterial pressure safely.
It would be reasonable to dilate the lesions sequentially in 2 procedures.
Résumé
Contexte
La lésion pulmonaire est une complication grave de l'angioplastie pulmonaire par ballonnet
(APB) réalisée dans les cas d'hypertension pulmonaire thromboembolique chronique (HPTC).
Le choix d'un ballon de plus petite taille pourrait permettre de réduire au minimum
la survenue d'une lésion pulmonaire; toutefois, un tel choix pourrait aussi accroître
le risque de resténose.
Méthodologie
Nous avons analysé les premières lésions cibles dans l'APB initiale réalisée chez
34 patients consécutifs présentant une HPTC. Nous avons mesuré la pression proximale
à l'aide d'un cathéter-guide et la pression distale à l'aide d'un fil-guide à capteur
de pression. Nous avons procédé à une analyse rétrospective des gradients de pression
au niveau des lésions avant et immédiatement après la dilatation initiale avec un
ballon plus petit et avant la seconde intervention.
Résultats
La pression proximale a diminué, et la pression distale a augmenté immédiatement après
la dilatation initiale du ballonnet. Le gradient de pression au niveau de la lésion
avait diminué de façon significative avant la seconde intervention (de 26,4 ± 10,7
à 18,2 ± 9,9 mm Hg, p < 0,001) sans complications graves. Le gradient de pression résiduel avait encore
diminué (à 9,8 ± 6,5 mm Hg, p = 0,02) jusqu’à la seconde intervention. La diminution du gradient de pression au
niveau de la lésion entre le moment suivant immédiatement la dilatation initiale du
ballon et la seconde intervention était positivement corrélée à la pression artérielle
pulmonaire moyenne au départ (r2 = 0,23, p = 0,004) et au gradient de pression résiduel immédiatement après la dilatation initiale
du ballon (r2 = 0,58, p < 0,001).
Conclusions
Le gradient de pression résiduel au niveau de la lésion a diminué de façon continue
après la dilatation avec un ballonnet de plus petite taille. Cette stratégie pourrait
permettre de réduire la pression artérielle pulmonaire en toute sécurité. Il serait
raisonnable de dilater les lésions en deux interventions séquentielles.
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Article info
Publication history
Published online: March 17, 2021
Accepted:
March 11,
2021
Received:
October 16,
2020
Footnotes
See page 1238 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
