Resultados hemodinámicos y clínicos de la angioplastia pulmonar con balón en pacientes con hipertensión pulmonar tromboembólica crónica en un centro de referencia en Bogotá, Colombia

Abstract

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by persistent thrombotic obstruction of the pulmonary arteries and subsequent vascular remodeling. The established treatment is surgery. However, in inoperable patients, balloon pulmonary angioplasty (BPA) emerges as an alternative treatment. We present the hemodynamic and clinical results of a cohort of patients undergoing BPA at LaCardio. Materials and Methods: Retrospective cohort of patients older than 18 years who underwent one or more BPA sessions between 2016 and September 2022. Qualitative variables are reported as absolute and relative frequencies; and the quantitative ones as measures of central tendency and dispersion. Results: 20 patients with 54 sessions of BPA were included, 13 (65%) were women, 100% under anticoagulation and 11 (55%) under treatment with Riociguat, with a baseline mean pulmonary pressure (PAPm) of 50±10.78 mmHg. Two BPA sessions were performed in 8 (40%) patients, 3 in 7 (35%), 4 in 4 (20%) and one in 1 (5%). An average of 17.32±7.13 lesions were treated per session, and the time between sessions was 91.6±134 days. After BPA, the mean PAPm was 38±11.86 mmHg, the mean pressure of the right atrium decreased from 12.1 to 8.1 mmHg, the pressure of the right ventricle decreased from 83/16 mmHg to 65/21 mmHg, the change of RV fractional area increased from 25.9% to 34% and TAPSE from 17.4 to 22 mm. The distance walked in 6 minutes increased from 494 ± 120.5 meters at baseline to 535 ± 106.96 meters after angioplasty. The perception of dyspnea at the end of the walk according to the BORG scale went from 4.07±2.87 to 2.26±2.68. Conclusion: In selected patients with CTEPH, BPA improves hemodynamics and clinical symptoms, decreases PAPm and improves other functional parameters of the right cardiac cavities, becoming an adequate therapeutic option in our patients.