Pulmonary perfusion changes after Balloon Pulmonary Angioplasty for chronic thromboembolic pulmonary hypertension

Abstract

Introduction: Balloon pulmonary angioplasty (BPA) is a treatment option for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persisting pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). The purpose of this study was to evaluate pulmonary perfusion changes after BPA by Dual-Energy Computed-tomography (DECT). Methods: Twenty segmental BPAs were performed in 6/7 inoperable patients and 1/7 patient with persisting PH after PEA (years: 70±11; mPAP: 38±3 mmHg; PVR:5±4 UW). We evaluated vascular permeability, pulmonary perfusion and pulmonary venous return using a 4-point scale (from 1: normal to 4: absence) on the angiography before and after BPA. DECT was performed prior and 3 months after BPA. Vascular permeability was rated using the same 4-point scale. For the lung perfusion study, iodine parenchymal concentration (CLung, ug.cm-3) was measured and normalized by the left atrial iodine concentration (CLA). Results: After BPA, we observed a significant increase in vascular permeability, pulmonary perfusion and pulmonary venous return on the pulmonary angiography (median score from 3 to 2; p Conclusions: Improved pulmonary perfusion was observed immediately after BPA on the angiography, confirmed 3 months later on DECT. Pulmonary perfusion assessed by DECT may be a non invasive indicator of BPA treatment effect.