High perfusion pressure as a predictor of reperfusion pulmonary injury after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. (June 2016)

• Record Type: Journal Article
• Authors: Kinutani, Hiroto; Shinke, Toshiro; Nakayama, Kazuhiko; Taniguchi, Yu; Otake, Hiromasa; Takaya, Tomofumi; Osue, Tsuyoshi; Konishi, Akihide; Emoto, Noriaki; Hirata, Ken-ichi
• Is Part Of: IJC heart & vasculature. Volume 11(2016)
• Page Start: 1
• Page End: 6
• Publication Date: 2016-06
• Subjects: BPA balloon pulmonary angioplasty -- CI cardiac index -- CO cardiac output -- CT computed tomography -- CTEPH chronic thromboembolic pulmonary hypertension -- IVUS intravascular ultrasound -- MLD minimal lumen diameter -- NIPPV non-invasive positive pressure ventilation -- PAG pulmonary angiography -- PAP pulmonary arterial pressure -- PCWP pulmonary capillary wedge pressure -- PEA pulmonary endarterectomy -- Pd mean pulmonary arterial pressure distal to the stenosis -- Pp mean pulmonary arterial pressure proximal to the stenosis -- PVR pulmonary vascular resistance -- ROC receiver-operating characteristic -- RPI reperfusion pulmonary injury -- 95% CI 95% confidence interval; Chronic thromboembolic pulmonary hypertension -- Balloon pulmonary angioplasty -- Reperfusion pulmonary injury -- Complication -- Predictor; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2015.11.006
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: Clinical efficacy of balloon pulmonary angioplasty (BPA) to the patients with non-operable chronic thromboembolic pulmonary hypertension (CTEPH) for improving pulmonary hemodynamics and exercise tolerance has been reported in these several years. However, reperfusion pulmonary injury (RPI) remains to be a major complication of BPA to overcome. This study elucidated the local predictor of RPI. Methods: Twenty-eight consecutive patients with non-operable CTEPH underwent BPA for lesions in the segmental or sub-segmental vessels. Pre- and post-BPA pulmonary arterial pressures at proximal (Pp) and distal (Pd) to the stenosis were measured by a 0.014-in. pressure wire. Positive or negative RPI was evaluated by chest computed tomography in each re-perfused segment separately 4 h after BPA. Results: Pressure measurements pre- and post-BPA were obtained from 110 lesions, where Pd and pressure ratio (Pd/Pp) increased after BPA in all lesions. Among them, RPI was observed in 49 lesions (44.5%). In the RPI-positive lesions, post-BPA Pd and post-BPA Pd/Pp were higher compared with the RPI-negative lesions. Multivariate logistic analysis revealed that the post-BPA Pd was independently associated with RPI incidence. Receiver operating characteristic curve analysis demonstrated the best cut-off value of 19.5 mm Hg for post-BPA Pd to predict RPI. Conclusions: High reperfusion pressure after BPA could be a predictor of RPI. Monitoring local pressure during BPA procedure may have a potential to reduce the incidence of RPI.