Abstract
ObjectiveTo investigate the long-term efficacy of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with Takayasu arteritis (TA) and pulmonary artery stenosis and pulmonary hypertension (PH).MethodsData from 183 lesions from 79 surgeries performed on 32 patients with TA and PH were analyzed. Symptoms, laboratory investigation results, World Health Organization (WHO) functional class, 6-min walk distance (6 MWD), hemodynamic parameters, and prognosis were analyzed at baseline and follow-up.ResultsThe mean (± SD) age of the 32 patients (28 female, 4 male) was 42.8 ± 11.9 years, and the median follow-up was 49.5 months (interquartile range, 26–71 months). Compared with baseline, changes in total bilirubin, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, 6 MWD, and WHO score functional class demonstrated significant differences (P<0.001). Echocardiography findings, right and left ventricular diameter, tricuspid annular plane systolic excursion, and estimated pulmonary artery systolic pressure were all improved (P=0.016, P<0.001, P<0.001, and P=0.005, respectively). Importantly, repeat right heart catheterization revealed that mean pulmonary artery pressure, pulmonary vascular resistance, and cardiac index also improved significantly at follow-up (P<0.001, P<0.001, and P=0.011, respectively). Pulmonary angiography revealed post-procedure restenosis in 64 (35.0%) lesions underwent PTPA within three to six months. Among three patients who underwent stent implantation, one experienced restenosis. Two patients died during the follow-up period, one from aggravation of right heart failure after lung infection, and the other in a traffic accident.ConclusionsResults of this study indicated that PTPA significantly improved clinical symptoms, exercise tolerance, and hemodynamic parameters in patients with TA pulmonary artery stenosis and PH. More importantly, reperfusion pulmonary edema significantly decreased, and no patient died of PTPA-related complications with guidance from the pressure wire.
Highlights
Takayasu arteritis (TA) is a chronic progressive inflammatory disease of unknown etiology that affects the aorta, its major branches, and pulmonary arteries [1]
Results of this study indicated that percutaneous transluminal pulmonary angioplasty (PTPA) significantly improved clinical symptoms, exercise tolerance, and hemodynamic parameters in patients with TA pulmonary artery stenosis and pulmonary hypertension (PH)
Treatment of pulmonary artery stenosis in patients with TA has been mainly limited to medical therapy
Summary
Takayasu arteritis (TA) is a chronic progressive inflammatory disease of unknown etiology that affects the aorta, its major branches, and pulmonary arteries [1]. Owing to the lack of specific clinical symptoms, pulmonary artery involvement (PAI) is often overlooked by physicians. Unlike pulmonary artery lesions caused by chronic thromboembolism, surgical treatment of pulmonary artery stenosis associated with arteritis has been avoided. There is a lack of therapeutic experience with endovascular treatment in patients with TA and pulmonary artery stenosis. Data regarding percutaneous transluminal pulmonary angioplasty (PTPA) in the treatment of pulmonary artery stenosis in patients with TA are mainly from case reports or very small series [5, 7, 8] and lack long-term follow-up results. With recent advances in endovascular treatment for chronic thromboembolic PH [9], PTPA has become a promising approach for pulmonary arterial lesions in patients with TA.
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