Efficacy Of Balloon Pulmonary Angioplasty In The Treatment Of Chronic Thromboembolic Pulmonary Hypertension

Objective:By collecting and analyzing the clinical data of patiens who diagnosed with chronic thromboembolic pulmonary hypertension（CTEPH）in the First Hospital of Jinlin Universityfrom 2019 to 2021,we research the efficacy of balloon pulmonary angioplasty（BPA）,determine whether this operation can reduce pulmonary artery pressure and improve the clinical symptoms and quality of life.Methods:The Clinical data of seven patients with CTEPH who received BPA treatment in the First Hospital of Jinlin University from January 2019 to January 2021 were collected.Each patient conformed to the diagnostic criteria for CTEPH and the surgical indications for BPA,but did not meet the surgical indications for pulmonary endarterectomy（PEA）,or they did not agree.Right atrial pressure（RAP）,right ventricular pressure（RVP）,mean pulmonary artery pressure（m PAP）,pulmonary systolic blood pressure（PASP）,pulmonary diastolic blood pressure（PADP）,pulmonary capillary wedge pressure（PCWP）,pulmonary vascular resistance（PVR）,cardiac output（CO）and cardiac index（CI）were measured by Swan-Ganz catheter during BPA operation.And we recorded pulmonary flow grade（PFG）according to the results of pulmonary angiography.Meanwhile the pressure guide wire was used to measure the fraction flow reserve（FFR）before and after balloon dilation,and the mean value was calculated.And we collected the B-type Natriuretic Peptide（BNP）,oxygen saturation（SaO₂）,WHO classification,6-minute walking distance（6-MWD）and related data of cardiac ultrasound including left atrial diameter,right atrial diameter,right ventricular diameter,left ventricular diastolic diameter and left ventricular ejection fraction（LVEF）.SPSS18.0 statistical analysis software was used for statistical analysis.Normally distributed data were descripted as（?）±S,while non-normal data were descripted as M（Q25,Q75）.Paired t test or Wilcoxon signed-rank test were used to compare the indicators before and after BPA treatment,and P<0.05 was considered statistically significant.Results:A total of 7 patients were included in this study,including 4 males and 3females,with an average age of 52.43±14.59 years old.7 patients received 14 times of BPA treatment in total,and 4 patients received more than 2 times of BPA treatment.And the result demonstrated that there were no significant differences in the left atrial diameter、left ventricular end-diastolic diameter、SaO₂、LVEF、RAP、RVP and PVR before and after BPA.However the m PAP was 51.25±9.22mm Hg before operation and 38.75±6.7mm Hg after operation,the difference was statistically significant（P=0.048）.PASP was 92.75±13.89mm Hg before operation and68.25±21.28mm Hg after operation,the difference was statistically significant（P=0.043）.And PCWP increased from 11±1.41mm Hg to 13.75±1.71mm Hg.CI increased from 2.83±0.98 L/（min×m²）to 3.75±0.81L/（min×m²）,and the difference was statistically significant（P<0.05）.PFG blood flow grade was significantly increased after BPA,and the difference was statistically significant（P<0.001）.FFR showed that postoperative vascular pressure increased from 0.43±0.08 to 0.66±0.07.Cardiac ultrasound indicated that the right atrial diameter decreased significantly from 59.5±9.36mm to 48.79±8.54mm,and the right ventricular diameter decreased from 44.14±11.29mm to 30.29±5.19mm.The BNP of patients decreased from447.29±241.1 ng/ml to 112.9±123.27ng/ml,and the difference was statistically significant（P=0.007）.The results of 6-MWD were significantly increased from324.17±60.45m m to 396.33±64.39m,P=0.046.The postoperative WHO cardiac function grade was also significantly reduced.Conclusions:Through the study of clinical data of 7 patients with CTEPH who underwent BPA surgery,we can come to a conclusion that BPA can significantly reduce the pulmonary artery pressure of patients with CTEPH,increase the pulmonary artery blood perfusion,improve the hemodynamic indicators.And BPA has great significance for strengthening cardiac and pneumonic functions.