Balloon Pulmonary Angioplasty (BPA) and Rehabilitation for Chronic Thromboembolic Pulmonary Hypertension (CTEPH).
Chronic thromboembolic pulmonary hypertension has a poor prognosis because of increased pulmonary arterial pressure causing pulmonary hypertension and progressive right-sided heart failure. Typical symptoms are dyspnea on exertion, fatigability, and reduced quality of life.
Balloon pulmonary angioplasty has been reported to improve hemodynamics and functional capacity in patients with CTEPH who are not candidates for pulmonary endarterectomy. However, the effect of BPA on respiratory function in patients with CTEPH is unclear.
Recently, Akizuki et al investigated how BPA affects hemodynamics, ventilatory efficiency, and gas exchange in patients with CTEPH using right heart catheterization, respiratory function testing, and cardiopulmonary exercise testing.
They enrolled patients with inoperable CTEPH who underwent BPA primarily in lower lobe arteries and upper and middle
lobe arteries. They compared changes in hemodynamics and respiratory function between different BPA fields.
They showed differences in the effect of BPA on respiratory function in different BPA fields in patients with CTEPH. Mean PAP and pulmonary vascular resistance significantly improved. Oxygenation at rest and during exercise improved regardless of the BPA field.
However, the time course of changes in the percent predicted diffusion capacity of lung for carbon monoxide, The ventilation/CO2 production slope, and FETCO2 was significantly different between lower and upper/middle lung BPA fields. %DLCO decreased after BPA in the lower lung field with no recovery.
However, %DLCO increased after BPA in the upper middle lung field and continued to improve during the follow-up. VE/VCO2 slope significantly improved after BPA in the lower lung field and continued to improve during the follow-up.
However, the VE/VCO2 slope remained unchanged after BPA in the upper/middle lung field. Therefore, the effect of BPA on respiratory function in patients with CTEPH differed depending on the lung field.
Pulm Res Respir Med Open J. 2017; 4(2): e1-e2. doi: 10.17140/PRRMOJ-4-e007