Author + information
- Received February 17, 2014
- Revision received May 24, 2014
- Accepted June 8, 2014
- Published online November 1, 2014.
- Takumi Inami, MD∗,
- Masaharu Kataoka, MD∗,†∗ (, )
- Nobuhiko Shimura, MD∗,
- Haruhisa Ishiguro, MD∗,
- Ryoji Yanagisawa, MD∗,
- Keiichi Fukuda, MD†,
- Hideaki Yoshino, MD∗ and
- Toru Satoh, MD∗∗∗ ()
- ∗Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
- †Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- ↵∗Reprint requests and correspondence:
Dr. Masaharu Kataoka, Department of Cardiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan.
- ↵∗∗Dr. Toru Satoh, Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan.
Objectives This study sought to prove the safety and effectiveness of pressure-wire-guided percutaneous transluminal pulmonary angioplasty (PTPA).
Background PTPA has been demonstrated to be effective for treatment of chronic thromboembolic pulmonary hypertension. However, a major and occasionally fatal complication after PTPA is reperfusion pulmonary edema. To avoid this, we developed the PEPSI (Pulmonary Edema Predictive Scoring Index). The pressure wire has been used to detect insufficiency of flow in a vessel.
Methods We included 350 consecutive PTPA sessions in 103 patients with chronic thromboembolic pulmonary hypertension from January 1, 2009 to December 31, 2013. During these 5 years, 140 PTPA sessions were performed without guidance, 65 with guidance of PEPSI alone, and 145 with both PEPSI and pressure-wire guidance. Each PTPA session was finished after achieving PEPSI scores of <35.4 with PEPSI guidance and each target lesion achieving distal mean pulmonary arterial pressure <35 mm Hg with pressure-wire guidance.
Results The occurrence of clinically critical reperfusion pulmonary edema and vessel injuries were lowest in the group using the guidance of both pressure wire and PEPSI (0% and 6.9%, respectively). Furthermore, the group guided by pressure wire and PEPSI accomplished the same hemodynamic improvements with fewer numbers of target lesions treated and sessions performed.
Conclusions The combined approach using pressure wire and PEPSI produced more efficient clinical results and greatly reduced reperfusion pulmonary edema and vessel complications. This is further evidence that PTPA is an alternative strategy for treating chronic thromboembolic pulmonary hypertension.
- chronic thromboembolic pulmonary hypertension
- percutaneous transluminal pulmonary angioplasty
- pressure wire
- Pulmonary Edema Predictive Scoring Index
- reperfusion pulmonary edema
All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Inami and Kataoka contributed equally to this work.
- Received February 17, 2014.
- Revision received May 24, 2014.
- Accepted June 8, 2014.
- American College of Cardiology Foundation