Orv Hetil. 2026 Jan 4;167(1):23-29. doi: 10.1556/650.2026.33464. Print 2026 Jan 4.
ABSTRACT
INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but potentially curable form of pulmonary hypertension. Pathology is characterized by persistent, organized thrombi causing mechanical vascular obstruction, often accompanied by a small-vessel vasculopathy. In 2023, balloon pulmonary angioplasty (BPA) was introduced in our institution as a new treatment option for managing CTEPH.
OBJECTIVE: To present the initial clinical and hemodynamic outcomes of BPA interventions launched as part of the complete CTEPH program established at Gottsegen György National Cardiovascular Center.
METHOD: In this retrospective study, we analyzed 38 inoperable patients diagnosed with CTEPH who underwent at least one BPA procedure between 2023 and 2024. Diagnosis was established according to the national guidelines. During BPA, balloon dilation was performed on stenosed or occluded segmental and subsegmental pulmonary arteries. The therapeutic efficacy was evaluated using echocardiographic, functional, laboratory, and hemodynamic parameters.
RESULTS: The majority of CTEPH patients were categorized within WHO functional class II and III. A total of 119 BPA sessions were performed in 38 patients. At the time of data analysis, the majority of patients (81.5%) had not yet completed their full BPA treatment course. In patients treated with BPA, TAPSE/SPAP ratio improved significantly from 0.3 ± 0.03 to 0.4 ± 0.05 mm/mmHg (p<0.05). A trend towards improvement was also observed in the 6-minute walk distance and NT-proBNP levels (409 ± 28 vs. 418 ± 32 m, p = 0.07; 2984 ± 1083 vs. 1168 ± 279 pg/mL, p = 0.05, respectiveli). BPA treatment led to significant reductions in mean pulmonary artery pressure (40 ± 2.3 vs. 35 ± 2.1 mmHg, p<0.05), mean right atrial pressure (9.4 ± 1.0 vs. 6.2 ± 0.8 mmHg, p<0.05), and pulmonary vascular resistance (PVR [based on thermodilution]: 7.1 ± 0.8 vs. 5.5 ± 0.5 WU, p<0.05). No periprocedural mortality occurred, and major complications were observed in only 1.7% of sessions.
CONCLUSION: BPA appears to be a safe and effective alternative therapy for CTEPH patients, providing notable hemodynamic improvement. The initial results of our program are promising for the future of CTEPH management in Hungary. Orv Hetil. 2026; 167(1): 23-29.
PMID:41485195 | DOI:10.1556/650.2026.33464