INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

PULMONARY BALLOON ANGIOPLASTY FOR CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

İlke Erbay

Zonguldak Bülent Ecevit University, Faculty of Medicine, Department of Cardiology, Zonguldak, Türkiye

Erbay İ. Pulmonary Balloon Angioplasty for Chronic Thromboembolic Pulmonary Hypertension. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.387-396.

ABSTRACT

Chronic thromboembolic pulmonary hypertension (CTEPH) results from persistent obstruction of pulmonary arteries due to unresolved thrombi, leading to increased pulmonary vascular resistance and right heart failure if left untreated. Pulmonary endarterectomy (PEA) remains the first-line treatment for surgically accessible cases. Still, balloon pulmonary angioplasty (BPA) has become a valuable alternative for inoperable patients or those with residual pulmonary hypertension after PEA.

BPA is a catheter-based procedure that improves pulmonary hemodynamics by dilating stenotic arteries. The procedure involves selective pulmonary angiography, guidewire navigation, and balloon inflation to optimize reperfusion. Advanced imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can enhance procedural safety. Although BPA is effective, complications such as vascular injury, hemoptysis, and lung injury may occur. In severe cases, careful lesion selection, undersized balloon use, and pre-treatment with riociguat help reduce risks.

BPA has significantly improved symptom relief, exercise capacity, and survival in CTEPH patients. However, cost-effectiveness data remain limited, and further studies are needed to compare BPA with PEA and medical therapy. Long-term management includes lifelong anticoagulation and follow-up assessments to prevent disease progression. As BPA techniques continue to evolve, ongoing research will further refine the patient selection, procedural strategies, and outcomes for CTEPH treatment.

Keywords: Chronic thromboembolic pulmonary hypertension; Balloon pulmonary angioplasty; Pulmonary embolism; Pulmonary hemodynamics; Right-sided heart failure

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