Background

Balloon pulmonary angioplasty improves the hemodynamics of patients with inoperable chronic thromboembolic pulmonary hypertension; however, the clinical impact of recurrent pulmonary hypertension after balloon pulmonary angioplasty remains unclear.

Methods

We retrospectively reviewed 262 consecutive patients with chronic thromboembolic pulmonary hypertension who underwent balloon pulmonary angioplasty between July 2009 and December 2020; 158 (65±12 years; males, 20%; median follow-up period, 45 [26,66] months) with follow-up right heart catheterization and no residual pulmonary hypertension were included. Recurrent pulmonary hypertension was defined as mean pulmonary arterial pressure <25 mmHg at the first evaluation after balloon pulmonary angioplasty and ≥25 mmHg at follow-up evaluation requiring additional treatment with balloon pulmonary angioplasty or pulmonary vasodilators.

Results

Recurrent pulmonary hypertension was observed in 11 patients; the state-occupation probability of recurrence at 5 years was 9.0% (95% CI: 5.0–18.9%). Only 1 case (0.6%) of recurrent pulmonary hypertension showed vascular restenosis and reocclusion of previously treated lesions, with more significant hemodynamic and exercise capacity deterioration than the other cases. Additional treatments for recurrent pulmonary hypertension (balloon pulmonary angioplasty in 9 patients, pulmonary vasodilators in 4 patients) improved the mean pulmonary arterial pressure from 27 [26,29] to 22 [19,23] mmHg (P<0.01). Recurrence had a low probability of transitioning to death in an illness-death model. No specific risk factors for recurrent pulmonary hypertension were identified.

Conclusions

Symptomatic recurrent pulmonary hypertension due to vascular restenosis or reocclusion after balloon pulmonary angioplasty was extremely rare. Most cases of recurrent pulmonary hypertension were mild, did not worsen clinically, and had favorable prognoses.

中文翻译：

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无法手术的慢性血栓栓塞性肺动脉高压球囊肺血管成形术后复发性肺动脉高压

 背景

球囊肺血管成形术改善了无法手术的慢性血栓栓塞性肺动脉高压患者的血流动力学；然而，球囊肺血管成形术后复发性肺动脉高压的临床影响仍不清楚。

 方法

我们回顾性分析了 2009 年 7 月至 2020 年 12 月期间接受球囊肺血管成形术的连续 262 例慢性血栓栓塞性肺动脉高压患者；纳入 158 名（65±12 岁；男性，20%；中位随访时间，45 [26,66] 个月）进行右心导管检查且无残余肺动脉高压的患者。复发性肺动脉高压的定义为球囊肺血管成形术后首次评估时平均肺动脉压<25mmHg，并且在需要球囊肺血管成形术或肺血管扩张剂额外治疗的后续评估时≥25mmHg。

 结果

11 例患者出现复发性肺动脉高压； 5 年时状态职业复发概率为 9.0%（95% CI：5.0-18.9%）。仅1例（0.6%）复发性肺动脉高压出现血管再狭窄和既往治疗病灶再闭塞，血流动力学和运动能力恶化较其他病例更为明显。针对复发性肺动脉高压的额外治疗（9 名患者接受球囊肺血管成形术，4 名患者接受肺血管扩张剂）将平均肺动脉压从 27 [26,29] 改善至 22 [19,23] mmHg (P<0.01)。在疾病-死亡模型中，复发转变为死亡的可能性很低。没有发现复发性肺动脉高压的具体危险因素。

 结论

球囊肺血管成形术后由于血管再狭窄或再闭塞而导致的症状性复发性肺动脉高压极为罕见。大多数复发性肺动脉高压病例病情较轻，临床上并未恶化，且预后良好。