Balloon pulmonary angioplasty in a patient with chronic thromboembolic pulmonary hypertension

We report the first French case of percutaneous balloon pulmonary angioplasty (BPA) in a 78-year-old patient with chronic thromboembolic pulmonary hypertension (CTEPH). The patient had a history of acute pulmonary embolism in 2004 with recurrence in 2011. At the end of 2012, he complained of persistent dyspnoea and CTEPH was diagnosed on lung radionuclide perfusion scan, contrast chest computed tomography and right heart catheterisation. At the first evaluation, he was in New York Heart Association (NYHA) functional class III and his 6-min walk distance (6MWD) was 470 m. Mean pulmonary artery pressure (mPAP) was 45 mmHg, cardiac index 1.8 L?min?m and pulmonary vascular resistance (PVR) 8 Wood units. He had used warfarin for 2 years, and combination therapy with bosentan and tadalafil was started (1 year before angioplasty) [1, 2]. Conventional pulmonary angiography showed that the main lesions were located in segmental pulmonary arteries of the lower lobes (fig. 1c). Webs, splits and occlusion were identified in A6, A8, A9 and A10 pulmonary arterial branches on the right lung, and A8, A9 and A10 on the left lung (fig. 1a).