POSITIVE PULMONARY ARTERY REMODELING AFTER A SERIES OF BALLOON PULMONARY ANGIOPLASTIES IN A PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

Abstract

Objective: To demonstrate positive pulmonary artery remodeling after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Design and method: A 68-year old female was admitted to pulmonary hypertension department with swelling of the feet and legs, low level of arterial blood saturation (92%). She passed two episodes of pulmonary embolism – 7 and 5 years before the hospitalization. The patient was treated with anticoagulants (warfarin), diuretics (furosemide, spironolactone). Invasive pulmonary angiography confirmed thromboembolic lesions of pulmonary artery. Another types of pulmonary hypertension, except CTEPH, were excluded. Multidisciplinary commission considered her as inoperable due to obesity and anemia of unknown origin. But it was technically possible to perform BPA. The patient underwent 5 sessions of BPA. Before and just after the first BPA and 3 months after the last BPA intravascular ultrasound (IVUS) of pulmonary arteries was performed. Results: According to the results of treatment the functional class improved in the patient (from 4 to 3), the distance in 6-minute walking test slightly increased (from 290 to 303 m), and the mean preassure in pulmonary artery decreased from 40 to 35 mm Hg. When assessing the size of the pulmonary arteries, underwent angioplasty, there were determined signs of positive remodeling (Table 1). According to invasive angiography the diameter of branches of the subsegmental arteries increased up to 14.3%. According to the results of IVUS, comparable results were obtained: 10% increase of the lumen diameter. Conclusions: successful series of BPA in patients with CTEPH can lead to the significant positive remodeling of pulmonary arteries.