Rescue balloon pulmonary angioplasty under veno-arterial extracorporeal membrane oxygenation in a patient with acute exacerbation of chronic thromboembolic pulmonary hypertension

International Heart Journal
Makiko NakamuraYutaka Okita

Abstract

We describe a case of a 41-year-old woman with acute exacerbation of chronic thromboembolic pulmonary hypertension (CTEPH) complicated by rapidly progressive respiratory failure and right heart failure with cardiogenic shock. A computed tomography (CT) showed thrombi in the right main pulmonary artery and bilateral peripheral pulmonary arteries, and echocardiography showed right ventricular dilatation and tricuspid regurgitation, with an estimated pressure gradient of 80 mmHg. The patient was initially diagnosed with acute pulmonary thromboembolism, and thrombolytic therapy was administered. Her condition subsequently deteriorated, however, necessitating mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We performed emergency catheter-directed thrombectomy and thrombus aspiration. Pulmonary hypertension (PH) temporarily improved, but subsequently worsened, and the patient was diagnosed with CTEPH. Pulmonary endarterectomy (PEA) was performed. After PEA, we were unable to wean the patient off VA-ECMO, and rescue balloon pulmonary angioplasty (BPA) to the middle and inferior lobe branches of the right lung was performed. Five days after BPA, the patient was removed from VA-ECMO and on the 57t...Continue Reading

References

May 28, 2004·The New England Journal of Medicine·Vittorio PengoUNKNOWN Thromboembolic Pulmonary Hypertension Study Group
Dec 23, 2006·Seminars in Thoracic and Cardiovascular Surgery·Patricia A ThistlethwaiteStuart W Jamieson
Feb 23, 2008·American Journal of Respiratory and Critical Care Medicine·Robin CondliffeJoanna Pepke-Zaba
Feb 19, 2011·American Journal of Respiratory and Critical Care Medicine·Peter FedulloWilliam R Auger
Nov 30, 2012·Circulation. Cardiovascular Interventions·Hiroki MizoguchiHiromi Matsubara
Jul 26, 2013·The New England Journal of Medicine·Hossein-Ardeschir GhofraniUNKNOWN CHEST-1 Study Group

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Citations

Jul 15, 2015·Current Opinion in Pulmonary Medicine·Takeshi Ogo
Mar 6, 2021·Interventional Cardiology·John G CoghlanStephen P Hoole
Dec 19, 2020·The European Respiratory Journal·Marion DelcroixGérald Simonneau
Jul 6, 2021·Current Opinion in Pulmonary Medicine·Hiroto ShimokawaharaHiromi Matsubara

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