BALLOON PULMONARY ANGIOPLASTY.

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease in which a pulmonary artery is occluded with a thrombus. This increases pulmonary resistance and, therefore, the afterload of the right heart, resulting in pulmonary hypertension. Balloon pulmonary angioplasty is a minimally invasive procedure to dilate stenosed pulmonary arteries, such as those in patients with CTEPH. During this procedure, a balloon catheter is inserted through a central vein from the right heart to the pulmonary arteries. At the site of stenosis, the balloon is inflated and dilates the stenotic material so that the arteries are open and perfusion is ensured. Case Report: With restricted availability in Romania due to a lack of expert centres, we present the case of a 49-y.o. patient, known with bilateral PE post episode of right femoral-popliteal DVT, under anticoagulant therapy with Warfarin, later diagnosed with pulmonary hypertension group 4 (subgroup 4.1) WHO-functional class III and thrombophilia (A1298C MTHFR gene heterozygous mutation). At the presentation (2019), an electrocardiogram showed sinus rhythm, right axis deviation with right bundle branch block, and signs of atrial and ventricular hypertrophy. Echocardiography and right heart catheterization presented signs of severe pulmonary hypertension. Mean NTproBNP values before PEA were above 4000 pg/mL, and the 6-minute walking distance(6MWD) measured 79% from predicted. The patient underwent specific national treatment with guanylate cyclase stimulator (indication IA European Guide ESC/ERS 2022) - total daily dose 3x2.5mg. Discussions : BPA improves the life expectancy and quality of the patients with access to this procedure. They can reduce or quit their medication, which will also reduce side effects and increase life quality. In May 2023, under collaboration with experts from Poland PH's interventional centre, the patient underwent BPA at the level of the inferior right pulmonary lobe. Assessment after one year showed an improvement of 7% in 6MWD and minimal signs of myocardial stress, as represented by NTproBNP values of 48 pg/mL. Conclusions: Balloon pulmonary angioplasty is a feasible interventional method in inoperable CTEPH, improving hemodynamic parameters, proper heart function, and exercise capacity. [ABSTRACT FROM AUTHOR]