Introduction: Percutaneous transluminal pulmonary angioplasty (PTPA) in expert center may be considered in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are technically non-operable or carry an unfavorable risk:benefit ratio for Pulmonary endarterectomy (PEA). Chronic thromboembolic disease (CTED) is defined as a subgroup of patients with chronic thromboembolic obstructions of pulmonary arteries present with exercise intolerance without signs of pulmonary hypertension at rest. Recent guidelines do not formally address CTED patients, PEA in some expert centers succeeded in improving symptom and exercise capacity in CTED.
Hypothesis: PTPA improves pulmonary hemodynamics, oxygenation and exercise capacity in patients with CTED.
Methods: Patients with dyspnea on effort of more than NYHA II, less than 25mmHg of mean pulmonary artery pressure (PAP) in right heart catheterization, organized thrombi in pulmonary angiography and segmental multiple defects in VQ scan were defined as CTED without PH. This study retrospectively included 22 patients with CTED before the treatment, who underwent PTPA from March 2012 to August 2016. Hemodynamic parameters such as PAP, pulmonary vascular resistance (PVR) and cardiac index (CI), partial pressure of arterial oxygen (PaO2), and 6-minute-walk distance(6MWD) were compared between before and after PTPA. All data were expressed by median [25th-75th percentile].
Results: The median age, the number of PTPA sessions performed per person and dilated vessels per person were 63[57-72] years old, 2[2-3] and 12[9-15] respectively. PTPA did not cause complications and mortality in all patients. Hemodynamic parameters such as PAP and PVR were significantly improved after PTPA as compared with the baseline, but CI was not significantly improved (PAP: 21[20-22] to 17[14-21] mmHg, P<0.01; PVR: 2.8[1.9-3.1] to 1.5[1.2-1.8], P<0.0001, CI: 3.2[2.9-3.4] to 3.2[2.9-4.0], P value > 0.05). Oxygenation and 6MWD were improved after PTPA (pO2 :69.3[65.8-77.5] to 74.7[65.6-91.2] mmHg, P<0.05; 6MWD: 380[338-434] to 410[361-450]m, P<0.01).
Conclusions: PTPA can safely improve pulmonary hemodynamics, oxygenation and exercise capacity in patients with CTED.