Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2020; 8(13): 2679-2702
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2679
Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: State of the art
Qi Jin, Zhi-Hui Zhao, Qin Luo, Qing Zhao, Lu Yan, Yi Zhang, Xin Li, Tao Yang, Qi-Xian Zeng, Chang-Ming Xiong, Zhi-Hong Liu
Qi Jin, Zhi-Hui Zhao, Qin Luo, Qing Zhao, Lu Yan, Yi Zhang, Xin Li, Tao Yang, Qi-Xian Zeng, Chang-Ming Xiong, Zhi-Hong Liu, State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
Author contributions: Jin Q, Zhao ZH and Luo Q contributed equally to the conception, literature review and manuscript drafting, and should be considered as co-first authors; Zhao Q, Yan L, Zhang Y, Li X, Yang T, Zeng QX and Xiong CM collected the data and revised the literature, and Liu ZH conceived and revised the paper. All authors read and approved the final manuscript.
Supported by the National Precision Medical Research Program of China, No. 2016YFC0905602.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Hong Liu, MD, PhD, Doctor, Professor, State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China. zhihongliufuwai@163.com
Received: March 22, 2020
Peer-review started: March 22, 2020
First decision: April 22, 2020
Revised: May 28, 2020
Accepted: June 10, 2020
Article in press: June 10, 2020
Published online: July 6, 2020
Processing time: 106 Days and 13.1 Hours
Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complex chronic disease in which pulmonary artery stenosis or obstruction caused by organized thrombus can lead to increased pulmonary artery pressure and pulmonary vascular resistance, ultimately triggering progressive right heart failure and death. Currently, its exact mechanism is not fully understood. Pulmonary endarterectomy (PEA) has immediate effects with low perioperative mortality and satisfactory prognosis in experienced expert centers for CTEPH patients with proximal lesions. Nevertheless, 37% of patients are deemed unsuitable for PEA surgery due to comorbidities and other factors, and nearly half of the operated patients have residual or recurrent pulmonary hypertension. Riociguat is the only approved drug for CTEPH, although its effect is limited. Balloon pulmonary angioplasty (BPA) is a promising alternative treatment for patients with CTEPH. After more than 30 years of development and refinements, emerging evidence has confirmed its role in patients with inoperable CTEPH or residual/recurrent pulmonary hypertension, with acceptable complications and comparable long-term prognosis to PEA. This review summarizes the pathophysiology of CTEPH, BPA history and development, therapeutic principles, indications and contraindications, interventional procedures, imaging modalities, efficacy and prognosis, complications and management, bridging and hybrid therapies, ongoing clinical trials and future prospects.

Keywords: Chronic thromboembolic pulmonary hypertension; Pulmonary endarterectomy; Balloon pulmonary angioplasty; Targeted therapy

Core tip: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious chronic disease with a poor prognosis if left untreated. Pulmonary endarterectomy (PEA) is the only curable treatment of choice for certain CTEPH patients with proximal vessel lesions. Balloon pulmonary angioplasty (BPA) is a promising alternative interventional option for patients with CTEPH, especially those with distal lesions or residual/recurrent pulmonary hypertension after PEA. Herein, we summarize the pathophysiology of CTEPH, the history and development of BPA, therapeutic principles, indications and contraindications, interventional procedures, imaging modalities, efficacy and prognosis, complications and management, bridging and hybrid therapies, ongoing clinical trials and future prospects.