切换至 "中华医学电子期刊资源库"
高级检索
中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2023, Vol. 11 ›› Issue (03) : 262 -267. doi: 10.3877/cma.j.issn.2095-5782.2023.03.012

综述

球囊肺动脉成形术在慢性血栓栓塞性肺动脉高压治疗中的进展
王金志, 陶新曹, 谢万木, 傅志辉, 赵蕴伟†(), 黄强†(), 翟振国†()   
  1. 100029　北京，中日友好医院呼吸中心呼吸与危重症医学科；100029　北京，中日友好医院国家呼吸中心；330006　江西南昌，南昌大学第一附属医院呼吸与危重症医学科
    100029　北京，中日友好医院呼吸中心呼吸与危重症医学科；100029　北京，中日友好医院国家呼吸中心
    154000　黑龙江佳木斯，佳木斯大学附属第一医院　呼吸与危重症医学科
  • 收稿日期:2022-12-01 出版日期:2023-08-25
  • 通信作者: 赵蕴伟, 黄强, 翟振国
  • 基金资助:
    中国医学科学院中央级公益性科研院所项目(2020-PT320-001); 中国医学科学院医学与健康科技创新工程(2021-I2M-1-049); 中央高水平医院临床科研业务费资助(2022-NHLHCRF-LX-01-01-02)

Recent advances in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Jinzhi Wang, Xincao Tao, Wanmu Xie, Zhihui Fu, Yunwei Zhao†(), Qiang Huang†(), Zhenguo Zhai†()   

  1. Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Center for Respiratory Medicine, Beijing 100029; Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanchang University, Jiangxi Nanchang 330006
    Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Center for Respiratory Medicine, Beijing 100029
    Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Jiamusi University, Heilongjiang Jiamusi 154000, China
  • Received:2022-12-01 Published:2023-08-25
  • Corresponding author: Yunwei Zhao, Qiang Huang, Zhenguo Zhai
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王金志, 陶新曹, 谢万木, 傅志辉, 赵蕴伟, 黄强, 翟振国. 球囊肺动脉成形术在慢性血栓栓塞性肺动脉高压治疗中的进展[J]. 中华介入放射学电子杂志, 2023, 11(03): 262-267.

Jinzhi Wang, Xincao Tao, Wanmu Xie, Zhihui Fu, Yunwei Zhao, Qiang Huang, Zhenguo Zhai. Recent advances in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2023, 11(03): 262-267.

慢性血栓栓塞性肺动脉高压（chronic thromboembolic pulmonary hypertension，CTEPH）是一种相对少见、可危及生命的肺血管疾病，属第四类肺动脉高压。以呼吸困难、乏力、运动耐量下降为主要表现的一类疾病。球囊肺动脉成形术（balloon pulmonary angioplasty，BPA）是治疗慢性血栓栓塞性肺动脉高压重要的方法。文章从BPA指征、对不同病变类型的治疗效果，安全性和有效性，并发症风险评估及处理策略，存在问题及挑战，研究与展望等进行综述。

关键词: 慢性血栓栓塞性肺动脉高压, 肺动脉内膜剥脱术, 球囊肺动脉成形术

Chronic thromboembolic pulmonary hypertension (CTEPH), a relatively rare, potentially life-threatening disease of the pulmonary vasculature, is a distinct entity (group 4) in the classification of pulmonary hypertension. The main clinical manifestations were dyspnea, fatigue and decreased exercise tolerance. Balloon pulmonary angioplasty (BPA) is an established management to treat patients with inoperable CTEPH. In this review, the indication, the therapeutic effect for different lesion types, safety, complications and the corresponding measures, technical and clinical challenges, as well as the prospects of the technique were discussed.

Key words: Chronic thromboembolic pulmonary hypertension, Pulmonary endarterectomy, Balloon pulmonary angioplasty
图1 CTEPH造影病变类型1A：白色箭头为A型病变；1B：白色箭头为B型病变；1C：白色箭头为C型病变；1D：白色箭头为D型病变；1E：白色箭头为E型病变。
[1]
陶新曹, 谢万木, 翟振国, 等. 中国肺动脉高压诊断与治疗指南(2021版)[J]. 中华医学杂志, 2021, 101(1): 11-51.
[2]
Mahmud E, Madani MM, Kim NH, et al. Chronic thromboembolic pulmonary hypertension: evolving therapeutic approaches for operable and inoperable disease[J]. J Am Coll Cardiol, 2018 May 29, 71(21): 2468-2486.
[3]
Shimokawahara H, Ogawa A, Matsubara H. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: advances in patient and lesion selection[J]. Curr Opin Pulm Med, 2021, 27(5): 303-310.
[4]
陶新曹, 彭文华, 谢万木, 等. 球囊肺动脉成形术治疗慢性血栓栓塞性肺动脉高压的效果和安全性[J]. 中华医学杂志, 2020, 100(6): 437-441.
[5]
Tzoumas A, Peppas S, Sagris M, et al. Advances in treatment of chronic thromboembolic pulmonary hypertension[J]. Thromb Res, 2022, 21(2): 30-37.
[6]
Alegria S, Calé R, Ferreira F, et al. Optical coherence tomography-guided balloon pulmonary angioplasty of a web lesion[J]. Rev Port Cardiol (Engl Ed), 2019, 38(3): 227-228.
[7]
Tamada N, Nakayama K, Yanaka K, et al. Early introduction of pulmonary endarterectomy or balloon pulmonary angioplasty contributes to better health-related quality of life in patients with chronic thromboembolic pulmonary hypertension[J]. JACC Cardiovasc Interv, 2018, 11(11): 1114-1116.
[8]
Ang L, McDivit Mizzell A, Daniels LB, et al. Optimal technique for performing invasive pulmonary angiography for chronic thromboembolic pulmonary disease[J]. J Invasive Cardiol, 2019, 31(7): 211-219.
[9]
Calé R, Ferreira F, Pereira AR, et al. Safety and efficacy of balloon pulmonary angioplasty in a Portuguese pulmonary hypertension expert center[J]. Rev Port Cardiol (Engl Ed), 2021, 40(10): 727-737.
[10]
Inami T, Kataoka M, Shimura N, et al. Pressure-wire-guided percutaneous transluminal pulmonary angioplasty: a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension[J]. JACC Cardiovasc Interv, 2014, 7(11): 297-306.
[11]
Lang IM, Andreassen AK, Andersen A, et al. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: a clinical consensus statement of the ESC working group on pulmonary circulation and right ventricular function [J]. Eur Heart J, 2023, 44(29): 2659-2671.
[12]
Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J]. Eur Heart J, 2022, 43(15): 3618-3731.
[13]
Andreassen AK, Ragnarsson A, et al. Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension[J]. Heart, 2013, 99(19): 1415-1420.
[14]
Gerges C, Friewald R, Gerges M, et al. Efficacy and safety of percutaneous pulmonary artery subtotal occlusion and chronic total occlusion intervention in chronic thromboembolic pulmonary hypertension[J]. Circ Cardiovasc Interv, 2021, 14(8): 266-313.
[15]
Kennedy MK, Kennedy SA, Tan KT, et al. Balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension- a systematic review and meta-analysis[J]. Circ J, 2019, 83(8): 1660-1667.
[16]
Ogawa A, Satoh T, Matsubara H, et al. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: results of a multicenter registry[J]. Circ Cardiovasc Qual Outcomes, 2017,10(11): 40-29.
[17]
Jaïs X, Brenot P, Bouvaist H, et al. Balloon pulmonary angioplasty versus riociguat for the treatment of inoperable chronic thromboembolic pulmonary hypertension (RACE): a multicentre, phase 3, open label, andomized controlled trial and ancillary follow-up study[J]. Lancet Respir Med, 2022, 10(10): 961-971.
[18]
李宜珊, 张竹, 谢万木, 等. 慢性血栓栓塞性肺动脉高压流行病学研究进展[J]. 中华结核和呼吸杂志, 2023, 46(6): 603-609.
[19]
Fedullo P, Kerr KM, Kim NH, et al. Chronic thromboembolic pulmonary hypertension[J]. Am J Respir Crit Care Med, 2011, 183(12): 1605-1613.
[20]
Velázquez M, Albarrán A, Hernández I, et al. Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension[J]. Circ CardiovascInterv, 2012, 5(6): 748-755.
[21]
Roik M, Wretowski D, Łabyk A, et al. Refined balloon pulmonary angioplasty driven by combined assessment of intra-arterial anatomy and physiology--Multimodal approach to treated lesions in patients with non-operable distal chronic thromboembolic pulmonary hypertension-Technique, safety and efficacy of 50 consecutive angioplasties[J]. Int J Cardiol, 2016, 20(3): 228-235.
[22]
Ghofrani HA, Kim NH, Medical and interventional therapies for inoperable CTEPH: a necessary combination?[J]. Lancet Respir Med, 2022, 10(10): 926-927.
[23]
Kawakami T, Matsubara H, Shinke T, et al. Balloon pulmonary angioplasty versus riociguat in inoperable chronic thromboembolic pulmonary hypertension (MR BPA): an open label, randomised controlled trial[J]. Lancet Respir Med, 2022, 10(10): 949-960.
[24]
Madani M, Mayer E, Fadel E, et al. Pulmonary Endarterectomy. Patient Selection, Technical Challenges, and Outcomes[J]. Ann Am Thorac Soc, 2016, 13, 134(24): 2030-2032.
[25]
Darocha S, Araszkiewicz A, Kurzyna M, et al. Balloon pulmonary angioplasty in technically operable and technically inoperable chronic thromboembolic pulmonary hypertension[J]. J Clin Med, 2021, 10(5): 10-38.
[26]
Inami T, Kataoka M, Yanagisawa R, et al. Long-term outcomes after percutaneous transluminal pulmonary angioplasty for chronic thromboembolic pulmonary hypertension[J]. Circulation, 2016, 13(4): 2030-2032.
[27]
Delcroix M, de Perrot M, Jaïs X, et al. Chronic thromboembolic pulmonary hypertension: realising the potential of multimodal managemen[J]. Lancet Respir Med, 2023, 14(23): 2213-2260.
[28]
Tanabe N, Kawakami T, Satoh T, et al. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: a systematic review[J]. Respir Investig, 2018, 56(4): 332-341.
[29]
Corsico AG, D'Armini AM, Cerveri I, et al. Long-term outcome after pulmonary endarterectomy[J]. Am J Respir Crit Care Med, 2008, 178(4): 419-424.
[30]
Kramm T, Eberle B, Guth S, et al. Inhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy[J]. Eur J Cardiothorac Surg, 2005, 28(6): 882-888.
[31]
Boulate D, Mercier O, Mussot S, et al. Extracorporeal life support after pulmonary endarterectomy as a bridge to recovery or transplantation: lessons from 31 consecutive patients[J]. Ann Thorac Surg, 2016, 102(1): 260-268.
[32]
Howden EJ, Ruiz-Carmona S, Claeys M, et al. Oxygen pathway limitations in patients with chronic thromboembolic pulmonary hypertension[J]. Circulation, 2021, 143(21): 2061-2073.
[33]
Kim NH, Delcroix M, Jais X, et al. Chronic thromboembolic pulmonary hypertension[J]. Eur Respir J, 2019, 53(1): 801-915.
[34]
Hsieh WC, Jansa P, Huang WC, et al. Residual pulmonary hypertension after pulmonary endarterectomy: A meta-analysis[J]. J Thorac Cardiovasc Surg, 2018, 156(3): 1275-1287.
[35]
陶新曹, 王金志, 翟振国, 等. 抢救性球囊肺动脉成形术治疗体外膜氧合支持的慢性血栓栓塞性肺动脉高压1例[J]. 中华结核和呼吸杂志, 2023, 46(4): 408-412.
[36]
Nakamura M, Sunagawa O, Tsuchiya H, et al. Rescue balloon pulmonary angioplasty under veno-arterial extracorporeal membrane oxygenation in a patient with acute exacerbation of chronic thromboembolic pulmonary hypertension[J]. Int Heart J, 2015, 56(1): 116-120.
[37]
Tabuchi I, Ogawa A, Shigetoshi M, et al. Low incidence of restenosis after successful balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension[J]. Cardiovasc Interv Ther, 2023, 38(2): 231-240.
[38]
Takashi Kawakami, Aiko Ogawa, Katsumasa Miyaji, et al. Response by kawakami et al to letter regarding article, "novel angiographic classification of each vascular lesion in chronic thromboembolic pulmonary hypertension based on selective angiogram and results of balloon pulmonary angioplasty"[J]. Circ Cardiovasc Interv, 2017, 10(2): 49-62.
[39]
Magoń W, Stępniewski J, Waligóra M, et al. Virtual histology to evaluate mechanisms of pulmonary artery lumen enlargement in response to balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension[J]. J Clin Med, 2020, 9(6): 16-65.
[40]
Sun L, Jiang Q, Xie Y, et al. Optical coherence tomography for hypertensive pulmonary vasculature[J]. Int J Cardiol, 2016, 22(2): 494-498.
[41]
Naohiko Nakanishi, Kuniyoshi Fukai, Hideo Tsubata, et al. Angioscopic evaluation during balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension[J]. Heart Lung Circ, 2019, 28(4): 655-659.
[42]
Aoki T, Sugimura K, Tatebe S, et al. Comprehensive evaluation of the effectiveness and safety of balloon pulmonary angioplasty for inoperable chronic thrombo-embolic pulmonary hypertension: long-term effects and procedure-related complications[J]. Eur Heart J 2017, 38(42): 3152-3159.
[43]
Kazmirczak F, Prisco SZ, Knoper R, et al. Effect of combination of balloon pulmonary angioplasty and medical therapy on reverse right ventricular remodeling and hemodynamics in chronic thromboembolic pulmonary hypertension[J]. J Invasive Cardiol, 2023, 35(6): 312-320.
[44]
Atas H, Mutlu B, Akaslan D, et al. Balloon pulmonary angioplasty in patients with inoperable or recurrent/residual chronic thromboembolic pulmonary hypertension: a single-centre Initial experience[J]. Heart Lung Circ, 2022, 31(4): 520-529.
[45]
Roik M, Wretowski D, Łabyk A, et al. Refined balloon pulmonary angioplasty driven by combined assessment of intra-arterial anatomy and physiology—Multimodal approach to treated lesions in patients with non-operable distal chronic thromboembolic pulmonary hypertension—Technique, safety and efficacy of 50 consecutive angioplasties[J]. Int J Cardiol, 2016, 20(3): 228-235.
[46]
Andersen S, Reese-Petersen AL, Braams N, et al. Biomarkers of collagen turnover and wound healing in chronic thromboembolic pulmonary hypertension patients before and after pulmonary endarterectomy[J]. Int J Cardiol, 2023, 38(4): 82-88.
[47]
De Perrot M, Gopalan D, Jenkins D, et al. Evaluation and management of patients with chronic thromboembolic pulmonary hypertension-consensus statement from the ISHLT[J]. J Heart Lung Transplant, 2021, 40(11): 1301-1326.
[1] 叶家欣, 丁一, 陈成, 陈涛, 陆立冲, 葛敏. 体外膜肺氧合在慢性血栓栓塞性肺动脉高压患者血栓内膜剥脱术围术期的应用[J]. 中华重症医学电子杂志, 2018, 04(03): 275-280.
[2] 王凤, 胡晓芸, 张叶钦. 慢性血栓栓塞性肺动脉高压治疗的新进展[J]. 中华临床医师杂志(电子版), 2017, 11(20): 2335-2339.
[3] 魏胜超, 邓堂, 廖勇, 金桂云, 王剑锋. 慢性血栓栓塞性肺动脉高压的治疗[J]. 中华介入放射学电子杂志, 2020, 08(04): 378-381.
[4] 周阳逸, 顾建平, 汪涛. 球囊肺动脉成形术治疗慢性血栓栓塞性肺动脉高压的现状[J]. 中华介入放射学电子杂志, 2020, 08(02): 184-188.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号