부산대학교 도서관

Introduction: Pulmonary artery angioplasty (PAA) is a treatment option for patients with pulmonary hypertension due to chronic thromboembolism, who are rejected for surgical pulmonary endarterectomy. However, according to published series, pulmonary injury rate during PA remains high, mostly due to wire perforation or pulmonary artery rupture/dissection after balloon inflation. Hypothesis: Current improvements in invasive techniques employed during PAA, such as IVUS, could contribute to reduction of complications. Stent implantation could treat acute severe elastic recoil after simple balloon dilatation. Methods: We analyzed 14 procedures of PAA made in 9 patients (68.2±12 years, 45% male). 6 patients were in III NYHA functional class and the remaining 3 in II NYHA functional class. All patients underwent basal TTE (mean TAPSE 14.4±2 mm; mean sPAP 79.1±29 mmHg), and a basal right heart catheterisation previous to PAA (mean sPAP 51.8±13 mmHg, pulmonary vascular resistance 12.4±5 UW and right atrial pressure 12.7±3 mmHg. Basal BNP was 366±225 pg/ml. Results: In our series, among the total of 14 procedures, 10 were IVUS guided. 74,9% of the procedures were performed on inferior lobes (58.3% on left inferior lobe and 16.6% in right inferior lobe), 16.6% in right superior lobe, and 8.3% in medium right lobe. Simple balloon dilatation was done in all cases, and 6 lesions (42.8%) were additionally treated with stent implantation (4 DES and 2 BMS) due to acute severe elastic recoil. In all cases stent was selected according to IVUS measurements.No complications were observed at inmediate or mid-term. Mean follow up was 22.6±12 months. 7 patients improved functional class (p<0.01) and 2 remained stable. Only a slight improvement was observed in mPAP (51,8 vs. 45.2 mmHg;p=0.09), and BNP (366 vs. 285 pg/dl;p=0.13). No clinical or angiographic complications related to stent were detected on the control angiography at 3-6 months follow-up. Conclusions: IVUS allows a better measurement of pulmonary artery and hence a more precise selection of stent. IVUS guided PAA may increase the safety of the procedure detecting potential complications. Stent implantation may be an option when acute severe elastic recoil occurs after simple balloon dilatation. [ABSTRACT FROM AUTHOR]