← All decks
Cardiology
Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
9 sections · 93 slides
Chronic thromboembolic pulmonary hypertension
- Definition of CTEPH
- Incidence after acute pulmonary embolism
- Microangiopathy in unobstructed vessels
- Natural history of untreated CTEPH
- Survival by mean pulmonary arterial pressure
- Components of CTEPH management
- General measures shared with PAH
- Management algorithm for CTEPH
Medical and surgical treatment
- Riociguat in inoperable CTEPH
- Other pharmacological agents
- Pulmonary endarterectomy as gold standard
- Determinants of operability
- Surgical technique of endarterectomy
- Outcomes after pulmonary endarterectomy
- Limits of pulmonary thrombo-endarterectomy
- Reasons a patient is deemed non-operable
- Targets of the three interventional treatments
Development of balloon pulmonary angioplasty
- Origins in branch pulmonary artery stenosis
- Feinstein 2001 case series
- Stagnation after the early series
- Japanese refinement of technique in 2012
- Survival with interventional versus medical therapy
- Right ventricular effects of BPA
- Biochemical and respiratory effects
Candidate selection and contraindications
- Indications for balloon pulmonary angioplasty
- Rescue and adjunctive roles after PEA
- Low benefit rather than high risk
- Anatomy unsuitable for BPA
- The CTEPH multidisciplinary team
- Conditions that mimic CTEPH
- Anatomical disease level and treatment choice
- Guideline status of BPA
- Residual risks and further selection factors
- Absolute contraindications to BPA
- Relative contraindications to BPA
Pulmonary arterial anatomy for the operator
- Branching of the main pulmonary arteries
- Segmental nomenclature of the lungs
- Lung perfusion zones and segmental nomenclature
- Left-right differences in segmental arteries
- Imaging to establish disease level
- Escalation when imaging is inconclusive
Procedural performance and lesion selection
- Identifying target pulmonary zones
- Angiographic classification of thromboembolic lesions
- Type E tortuous lesions and high-risk zones
- Angiographic classification of thromboembolic lesions
- Priority order for lesion intervention
- Priority order by lung and lobe
- Vascular access and periprocedural anticoagulation
- Radiation and contrast limits
- Selective cannulation of segmental origins
- Lesion assessment before dilatation
- Balloon rupture of a web stenosis
- Endpoints for balloon dilatation
- When brisk venous return is not achieved
- Sequential balloon upsizing across sessions
- Balloon pulmonary angioplasty of right A4, A7 and left A9
- Angioplasty of right A1 bifurcation and left A5 with pressure arterialization
Complications of balloon pulmonary angioplasty
- Early complication rates
- Trends in complications over time
- Reasons for improved safety
- Lung injury after BPA
- Vascular complications in tortuous lesions
- Haemoptysis and vascular injury
- Wire specification and contingency planning
Post-procedure care and follow-up
- Immediate post-procedure care
- Number of sessions required
- Follow-up assessment after BPA
- Cardiopulmonary exercise testing in follow-up
- Summary of BPA benefits
- Remaining limitations and requirements
- Key take-home points
References
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
- Join our WhatsApp groups