1. Vascular Injury Is a Major Cause of Lung Injury After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension
- Author
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Aiko Ogawa, Hiromi Matsubara, Kentaro Ejiri, Shinya Fujii, and Hiroshi Ito
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,Time Factors ,Computed Tomography Angiography ,Pleural effusion ,Hypertension, Pulmonary ,medicine.medical_treatment ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Lung injury ,Balloon ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine.artery ,Angioplasty ,Multidetector Computed Tomography ,medicine ,Humans ,Arterial Pressure ,In patient ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,urogenital system ,business.industry ,Lung Injury ,Middle Aged ,Vascular System Injuries ,medicine.disease ,Respiration, Artificial ,Treatment Outcome ,030228 respiratory system ,Chronic Disease ,Pulmonary artery ,Angiography ,Cardiology ,Female ,Chronic thromboembolic pulmonary hypertension ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,hormones, hormone substitutes, and hormone antagonists - Abstract
Background: Balloon pulmonary angioplasty (BPA) has become an alternative treatment for inoperable patients with chronic thromboembolic pulmonary hypertension. Lung injury (LI) is a major complication of BPA and may attenuate the benefits of BPA. Therefore, we conducted a retrospective study to evaluate the association between patient and procedural characteristics and LI in patients with chronic thromboembolic pulmonary hypertension. Methods and Results: We reviewed 76 patients with chronic thromboembolic pulmonary hypertension who underwent BPA and multidetector computed tomography scanning pre- and post-BPA procedures. We performed BPA on 1247 vessels during 297 BPA procedures and reviewed 594 multidetector computed tomography scans. By comparing pre- and post-BPA multidetector computed tomography images, we diagnosed LI as follows: newly appeared ground-glass opacity, consolidation, and pleural effusion. LI was detected using multidetector computed tomography scans during 138 procedures (47%), and mechanical ventilation was required during 40 procedures (13%). Angiographic findings of extravasation with or without simultaneous clinical symptoms (BPA-related vascular injury) occurred during 50 procedures (17%). In mixed-effect logistic regression models, the BPA-related vascular injury was an independent predictor of LI after BPA, odds ratio, 20.1 (6.43–63.1). High mean pulmonary artery pressure before BPA procedure and BPA-related vascular injury were independent predictors of mechanical ventilation after BPA, odds ratio, 1.13 (1.03–1.24) and 10.8 (3.77–30.9), respectively. Conclusions: Vascular injury during BPA could be a triggering factor of LI after BPA, and its severity could be exacerbated by a high pulmonary artery pressure.
- Published
- 2018