Korean Circ J.  2019 Mar;49(3):214-222. 10.4070/kcj.2018.0380.

Chronic Thromboembolic Pulmonary Hypertension: Endovascular Treatment

• Ahn CM
• Hiromi M

• KMID: 2438532
• DOI: http://doi.org/10.4070/kcj.2018.0380

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare cause of pulmonary hypertension; less than 5% of pulmonary hypertension is caused by recurrent pulmonary thromboembolism (PTE). By definition, CTEPH happens within the first two years after symptomatic PTE; however, cases are often diagnosed without a history of acute PTE. Because of the poor functional status and chronicity of this disease, the classic and curative strategy of open pulmonary endarterectomy cannot be applied in some patients with lesions that involve the distal subsegmental pulmonary artery. Bridging therapy is needed for cases that are technically operable but have an unacceptable risk-benefit assessment or residual symptomatic pulmonary hypertension following surgical removal. Groups in Europe and Japan recently introduced balloon pulmonary angioplasty or percutaneous transluminal pulmonary angioplasty, which has led to significant improvement in functional and hemodynamic parameters in patients with CTEPH. This article introduces recent updates in patient selection and interventional procedures for this chronic and devastating disease.

Keyword

Hypertension, pulmonary; Pulmonary embolism; Thromboembolism; Angioplasty

MeSH Terms

Angioplasty
Endarterectomy
Europe
Hemodynamics
Humans
Hypertension, Pulmonary*
Japan
Patient Selection
Pulmonary Artery
Pulmonary Embolism
Risk Assessment
Thromboembolism

Figure

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  Figure 1 Basic anatomy of pulmonary artery by angiogram according to projection, either posterior-anterior or left anterior oblique 60 degree.LA = left pulmonary artery; RA = right pulmonary artery.

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  Figure 2 Classification of lesion morphology by angiogram. Various morphology types are detected by angiogram in patients with chronic thromboembolic pulmonary hypertension: intravascular web, ring-like, subtotal, and total occlusion types. CTO with collateral circulation or diffuse tortuous/distal type is also observed.CTO = chronic total occlusion.

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  Figure 3 Angiogram before and 1 month after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension.

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  Figure 4 Sheath and guiding catheter system. Dual long-sheath and guiding catheters are needed in balloon pulmonary angioplasty procedures because the stable position of the long-sheath at the main pulmonary artery provides support to guide catheter movement in selection of each segmental pulmonary artery.

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