Balloon pulmonary angioplasty
Summary
Balloon pulmonary angioplasty (BPA) is a promising therapeutic option for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy. The effect of BPA was first reported in 1988, and a few institutions in Japan, including ours, reported refinements of BPA in 2012. BPA has been gaining acceptance worldwide, and it is recognised as a therapeutic option for inoperable patients with chronic thromboembolic pulmonary hypertension in the latest guidelines. Although the efficacy and safety of BPA appear to be comparable to those of pulmonary endarterectomy, many questions remain to be resolved. We will review recent advances in BPA and changes to strategies, including indication, fundamental technique, complications, bail-out technique, outcomes, and treatment goals. Additionally, we address the limitations and future perspectives of BPA.
Introduction
Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension caused by stenosis or obstruction of the pulmonary arteries, which increases pulmonary vascular resistance due to organised thrombi 1. The only established and potentially curative treatment currently available for CTEPH is pulmonary endarterectomy (PEA) 2
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