China
Africa
Explore chapters and articles related to this topic
The Patient with Non-Group 2 Pulmonary Hypertension
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Sophia Anastasia Mouratoglou, George Giannakoulas
Percutaneous balloon pulmonary angioplasty is a treatment option in selected patients with inoperable CTEPH or residual PH after PEA. The technique attracts interest as an alternative to PEA as it offers an option to improve hemodynamics and functional status at limited cost and with few complications when performed in expert centers.2
Right heart catheterisation and evaluation of the pulmonary hypertension patient
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
PH is a life-threatening condition that was defined by a mPAP 25 mmHg measured by RHC in the supine position at rest since the 1st World Symposium of Pulmonary hypertension (WSPH) in 1973, Geneva, Switzerland. Accumulating data in healthy individuals, however, suggest that a normal mPAP at rest is 14 ± 3.3 mmHg.8 At the recent 6th World Symposium of Pulmonary hypertension, Nice, France (6th WSPH 2018), the upper limit of normal value was altered to be 20 mmHg, calculated as the mean normal value of 14 mmHg plus 2 standard deviations.9 This was based on recognition that in a number of conditions, mPAP > 20 mmHg was associated with increased mortality.10–13 As the increase in mPAP can be due to many conditions, such as increase in the CO, elevation in PAWP, left to right shunt, and pre-capillary PH with pulmonary vascular disease (PVD), it was considered important to redefine pre-capillary PH as mPAP > 20 mmHg, PAWP < 15 mmHg and PVR > 3 Wood Units (WU).9 This is because in this setting, some therapies in certain conditions have been shown to improve outcome. In particular, in PH group 1 (PAH), medications targeting the endothelin, nitric oxide and prostacyclin pathways and PH group 4, chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary endarterectomy,14 balloon pulmonary angioplasty15 and riociguat.16
Pediatric And Adult Congenital Cardiac Interventions
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Sawsan M. Awad, Qi-Ling Cao, Ziyad M. Hijazi
Variable modalities of percutaneous techniques include balloon pulmonary angioplasty using high-pressure balloons (Figure 47.4), cutting balloon angioplasty, and intravascular stent placement. Despite advances in balloon types and pressure achieved, around one-third of vessels, more often distal, are resistant to angioplasty. The use of cutting balloons is an effective treatment for small lobar PAS refractory to balloon angioplasty.21 Stenting of branch pulmonary arteries is frequently used in children with PAS and/or hypoplasia.22−24 Because of the higher immediate success and less incidence of restenosis, stenting of pulmo nary arteries may be a reasonable first-line therapy.
Evaluating cardiopulmonary function following acute pulmonary embolism
Published in Expert Review of Cardiovascular Therapy, 2022
Mads Dam Lyhne, Alison S Witkin, Giridhar Dasegowda, Christopher Tanayan, Mannudeep K. Kalra, David M. Dudzinski
For patients with CTEPH, there are multiple published treatment algorithms, with pulmonary thromboendarterectomy (PTE) being the treatment of choice and balloon pulmonary angioplasty (BPA) and medical therapy being alternatives for those who are not candidates for surgery or with residual disease following PTE [132]. However, for those with possible CTED, evaluation requires a multimodal approach to determine the relative contribution from the chronic PE as well as to determine appropriate treatment. In particular, CPET testing has emerged as a key test in identifying patients with clinically significant CTED. Invasive CPET (namely testing performed with concurrent right heart catheter) can detect pulmonary vascular limits to exercise and measure dead space. Combined with anatomic assessment of clot burden (typically with a conventional invasive pulmonary angiogram, occasionally CTPA or MRA may be used), functional exercise assessment can identify patients with CTED who may benefit from PTE or BPA [162,163]. Additional research into specific imaging techniques (DECT, MRA, various ultrasound based vascular-imaging modalities like intravascular ultrasound, and optical coherence tomography) and algorithms are needed to better understand the optimal cardiopulmonary evaluation for post-PE patients. Future research may be able to identify roles for biomarkers and metabolic and molecular circulating signatures of CTEPH and CTED that may augment and complement imaging and functional evaluation.
Chronic Thromboembolic Disease: Epidemiology, Assessment with Invasive Cardiopulmonary Exercise Testing, and Options for Management
Published in Structural Heart, 2021
W. Cameron McGuire, Mona Alotaibi, Timothy A. Morris, Nick H. Kim, Timothy M. Fernandes
Dyspnea on exertion and exercise limitation are very common after an acute PE and may be due to a variety of factors, including chronic thromboembolic disease. In this subset of patients, the invasive cardiopulmonary exercise test with right heart catheterization to obtain rest and exercise hemodynamics is helpful for elucidating the cause of the patient’s exercise limitation and excluding other etiologies that would not respond well to surgical intervention. Two distinct phenotypes of CTED, exercise-induced pulmonary hypertension and increased dead space ventilation, can be diagnosed on iCPET as well as exclusion of other causes of dyspnea on exertion such as heart failure with preserved ejection fraction that is unmasked with exercise. Though controversial, there is likely a role for pulmonary thromboendarterectomy at experienced centers for patients with functional limitation from their CTED and a clear phenotype. The role for balloon pulmonary angioplasty and/or medical therapy is less clear.
Pulmonary vascular diseases
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2020
Jason Weatherald, Vicky Mai, Steeve Provencher
From a therapeutic point of view, balloon pulmonary angioplasty (BPA) has emerged as an effective option in the treatment of CTEPH. While pulmonary endarterectomy remains the treatment of choice for eligible patients, many patients with surgically inaccessible chronic thromboembolic lesions and those deemed inoperable due to medical comorbidities may benefit from BPA.23 The relative therapeutic positions of riociguat, which is currently the only Health Canada-approved medical therapy for CTEPH, and BPA are being addressed in a randomized trial (https://clinicaltrials.gov/ct2/show/NCT02634203). In recently presented data from this study at the 2019 ERS Congress, BPA led to greater improvements in symptoms and hemodynamics compared to riociguat at 26 weeks, but there were more treatment-related serious adverse events with BPA. While results on the sequential combination of BPA and riociguat are still pending, BPA is an exciting potential treatment option with accumulating evidence of benefit for patients with inoperable CTEPH.