球囊肺动脉成形术治疗慢性血栓栓塞性肺动脉高压的安全性和有效性分析

目的:评估慢性血栓栓塞性肺动脉高压(CTEPH)患者行球囊肺动脉成形术(BPA)的安全性和有效性。方法:连续入选2018年5月至2018年10月于我中心拟行BPA治疗的CTEPH患者22例。收集患者的性别、年龄、体重指数、症状持续时间、心功能分级、6分钟步行距离(6MWD)、血浆中N末端B型利钠肽原(NT-proBNP)的表达水平等资料。行右心导管检查,测定肺血管血流动力学参数,并行肺动脉造影检查和BPA。比较BPA术前及术后各指标的差异。结果:21例CTEPH患者接受BPA治疗,其中男性11例,女性10例,平均年龄(59.24±8.69)岁(47~76岁),体重指数(23.5±3.8) kg/m2,症状持续时间(1.95±1.76)年。WHO心功能分级Ⅱ级10例(47.6%),Ⅲ级11例(52.4%)。患者平均扩张(3.24±1.92)支(1~9支)肺段动脉,(3.9±2.0)支(1~9支)亚段动脉,行肺动脉球囊扩张后,肺动脉压力和NT-proBNP显著下降,心功能和6MWD显著改善(P均<0.05)。无并发症发生。1例患者因导丝通过狭窄血管时出现咳嗽,咯血,终止操作。结论:BPA治疗后,肺动脉压力、心功能、NT-proBNP和6MWD均明显改善,无并发症发生,提示BPA具有短期良好的安全性和有效性。

Safety and Efficacy of Balloon Pulmonary Angioplasty in the Treatment of Chronic Thromboembolic Pulmonary Hypertension

Objectives: To evaluate the safety and efficacy of balloon pulmonary angioplasty(BPA) in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods: Twenty-two CTEPH patients, intended to receive BPA procedures from May 2018 to October 2018 in our center, were consecutively enrolled. Patient data including gender, age, body mass index, symptom duration, WHO functional class, 6-minute walking distance(6 MWD), and plasma NT-proBNP levels were collected. Right heart catheterization was performed to determine pulmonary vascular hemodynamic parameters, pulmonary angiography and BPA were also performed.Differences of related parameters between preoperative and postoperative BPA were compared.Results: Twenty-one CTEPH patients(11 males and 10 females, average age: [59.24±8.69] years [47-76 years], body mass index: [23.5±3.8] kg/m2, symptom duration: [1.95±1.76] years) finished BPA procedures. The number of patients with WHO functional class II and III were 10(47.6%) and 11(52.4%) respectively. 3.24±1.92(1-9) segmental arteries and 3.9±2.0(1-9) subsegmental arteries were dilated. The pulmonary artery pressure and NT-proBNP significantly decreased, while WHO functional class and 6 MWD apparently improved after BPA. No complications were observed. One patient developed cough and hemoptysis at the time when the guidewire passed through the stenotic vessel, then the procedure was stopped.Conclusions: The pulmonary artery pressure, cardiac function, NT-proBNP and 6 MWD are significantly improved after BPA, and no complications occurred, suggesting that BPA has desirable safety and efficacy profiles within the observed shortterm period post BPA.