TY - JOUR
T1 - Effects of balloon pulmonary angioplasty on oxygenation in patients with chronic thromboembolic pulmonary hypertension - Importance of intrapulmonary shunt
AU - Aoki, Tatsuo
AU - Sugimura, Koichiro
AU - Nochioka, Kotaro
AU - Miura, Masanobu
AU - Tatebe, Shunsuke
AU - Yamamoto, Saori
AU - Yaoita, Nobuhiro
AU - Suzuki, Hideaki
AU - Sato, Haruka
AU - Kozu, Katsuya
AU - Miyata, Satoshi
AU - Satoh, Kimio
AU - Shimokawa, Hiroaki
N1 - Publisher Copyright:
© 2016, Japanese Circulation Society. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Background: Although balloon pulmonary angioplasty (BPA) improves the hemodynamics and prognosis of patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), the mechanisms of improvement in oxygenation remain to be elucidated. Methods and Results: From August 2013 to May 2015, we performed a total of 113 BPA procedures in 24 patients with inoperable CTEPH (mean 4.7 procedures per patient). Median age was 70 [60, 74] years and 18 were female (75%). We examined hemodynamics, respiratory functions, and intrapulmonary shunt before and after the BPA procedure. Mean pulmonary arterial pressure (37 [28, 45] to 23[19, 27] mmHg, P<0.01), pulmonary vascular resistance (517 [389, 696] to 268 [239, 345] dyne/s/cm5) and 6-min walk distance (390 [286, 484] to 490 [411, 617] m, P<0.01) were significantly improved after BPA therapy. Furthermore, arterial oxygen partial pressure (PaO2, 54.8 [50.0, 60.8] to 65.2 [60.6, 73.2] %, P<0.01) and intrapulmonary shunt (23.4±6.0% to 19.3±5.0%, P<0.01) were also significantly ameliorated. In the multivariate analysis, decrease in intrapulmonary shunt after BPA was significantly correlated with improvement of both PaO2 (r2=0.26, P<0.01) and SaO2 (r2=0.49, P<0.01) after BPA. Conclusions: These results indicated that BPA improved not only pulmonary hemodynamics but also oxygenation with a resultant decrease in intrapulmonary shunt.
AB - Background: Although balloon pulmonary angioplasty (BPA) improves the hemodynamics and prognosis of patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), the mechanisms of improvement in oxygenation remain to be elucidated. Methods and Results: From August 2013 to May 2015, we performed a total of 113 BPA procedures in 24 patients with inoperable CTEPH (mean 4.7 procedures per patient). Median age was 70 [60, 74] years and 18 were female (75%). We examined hemodynamics, respiratory functions, and intrapulmonary shunt before and after the BPA procedure. Mean pulmonary arterial pressure (37 [28, 45] to 23[19, 27] mmHg, P<0.01), pulmonary vascular resistance (517 [389, 696] to 268 [239, 345] dyne/s/cm5) and 6-min walk distance (390 [286, 484] to 490 [411, 617] m, P<0.01) were significantly improved after BPA therapy. Furthermore, arterial oxygen partial pressure (PaO2, 54.8 [50.0, 60.8] to 65.2 [60.6, 73.2] %, P<0.01) and intrapulmonary shunt (23.4±6.0% to 19.3±5.0%, P<0.01) were also significantly ameliorated. In the multivariate analysis, decrease in intrapulmonary shunt after BPA was significantly correlated with improvement of both PaO2 (r2=0.26, P<0.01) and SaO2 (r2=0.49, P<0.01) after BPA. Conclusions: These results indicated that BPA improved not only pulmonary hemodynamics but also oxygenation with a resultant decrease in intrapulmonary shunt.
KW - Balloon pulmonary angioplasty
KW - Chronic thromboembolic pulmonary hypertension
KW - Intrapulmonary shunt
KW - Oxygenation
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U2 - 10.1253/circj.CJ-16-0254
DO - 10.1253/circj.CJ-16-0254
M3 - Article
C2 - 27581344
AN - SCOPUS:84988592583
VL - 80
SP - 2227
EP - 2234
JO - Circulation Journal
JF - Circulation Journal
SN - 1346-9843
IS - 10
ER -