Pulmonary balloon angioplasty for chronic thromboembolic pulmonary hypertension

Chronic thromboembolic disease occurs when thromboemboli integrate into the wall of the pulmonary arteries, resulting in obstruction in the pulmonary vasculature. CTEPH can occur in the proximal, larger and/or distal, smaller pulmonary arteries. Surgical resection of the occlusive lesions has been the standard of care of proximal CTEPH, while resection of distal CTEPH is technically challenging. Pulmonary balloon angioplasty has emerged as an effective option to treat distal CTEPH. It involves percutaneous techniques, using wires and coronary artery balloon, to perform angioplasty of these distal lesions. Such procedures require careful planning, including lesion selection and pulmonary edema preventative strategies. This chapter reviews the steps in planning, execution and postoperative care in patients undergoing pulmonary balloon angioplasty.