The goal of balloon pulmonary angioplasty is to open up the narrowed or blocked pulmonary arteries in the lungs, thereby reducing the pressure in the pulmonary circulation and improving blood flow and oxygenation.
Balloon pulmonary angioplasty (BPA) is a minimally invasive catheter-based procedure designed to treat chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a rare and severe form of pulmonary hypertension where persistent blood clots (thrombi) in the pulmonary arteries scar and narrow the vessels, leading to dangerously high blood pressure in the lungs. This high pressure forces the right side of the heart to work much harder, eventually leading to heart failure.
Balloon pulmonary angioplasty is a very uncommon and specialized procedures since the underlying condition, chronic thromboembolic pulmonary hypertension (CTEPH), is itself rare. While acute pulmonary embolism (blood clot in the lung) is relatively common, only a small percentage (around 0.5% to 5%) of patients who survive an acute pulmonary embolism go on to develop chronic, organized clots that cause CTEPH. BPA is a technically demanding and requires significant expertise and experience. It's only performed in a limited number of highly specialized centers worldwide with dedicated CTEPH programs, like AHN.
Given the rarity of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and highly complex nature of the balloon pulmonary angioplasty, seeking care from a dedicated and experienced center like AHN is critical. AHN is one of the few providers with a dedicated CTEPH program. Here you will be under the care of cardiologists who have performed this complex procedure numerous times and have improved patient outcomes. At AHN, we see you and your unique needs first.
BPA is a minimally invasive procedure that is performed in a specialized hospital setting, specifically in a cardiac catheterization lab (sometimes called an interventional cardiology suite or a hybrid operating room). These labs are equipped with advanced imaging technology (like fluoroscopy, which uses X-rays to visualize the inside of the body) and specialized tools required for these intricate procedures.
The BPA procedure is typically performed over several sessions, not just one, because many different segments of the lung arteries often need to be treated. Each session usually lasts a few hours.
Here's what you can expect prior to the procedure:
During the procedure:
The recovery from balloon pulmonary angioplasty is a multistage process that spans from immediately after each procedure session to a longer period of gradual improvement and ongoing management.
Immediately after each BPA session, the patient is transferred to a recovery area or sometimes a specialized cardiac unit. Here, nurses closely monitor vital signs (heart rate, blood pressure, oxygen saturation), the catheter insertion site (usually in the groin), and watch for any potential complications.
Patients will typically need to lie flat for several hours (often four to six hours) after the procedure. This is crucial to prevent bleeding or bruising at the site where the catheter was inserted. Movement of the limb where the access was gained (e.g., leg if groin access) will be restricted.
Mild discomfort or bruising at the access site is common. Some patients may experience a sensation of chest tightness or mild chest pain, which is usually manageable with over-the-counter pain relievers.
For the initial sessions, or if any concerns arise, patients often stay in the hospital overnight for observation. For later, uncomplicated sessions, it might sometimes be an outpatient procedure, meaning they go home the same day.
Patients are encouraged to drink plenty of fluids to help flush the contrast dye from their system. It's common to feel tired or fatigued for a few days after each procedure. The body is working to heal and adjust.
For a few days after each session, patients are generally advised to:
Regular follow-up with the cardiologist/pulmonologist is crucial. These appointments involve:
A heart procedure as complex and rare as balloon pulmonary angioplasty (BPA) can bring about questions and, potentially, concerns. AHN is here to help you feel confident in your understanding of this procedure. Your AHN care team is available to help answer your specific questions and guide you through the process. But, to help familiarize you with the procedure, we’ve included some of our patients’ most frequently asked questions. Many patients use this information to guide conversations with their care team.
The survival rate for balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH) has significantly improved as the procedure has evolved and operator experience has grown. While specific percentages can vary depending on the study, patient population, and definition of survival (e.g., in-hospital, 30-day, one-year), contemporary studies often report very favorable outcomes.
For instance, one-year survival rates after BPA in specialized centers are frequently reported to be over 90%, and in some cohorts, even higher.* Long-term survival also demonstrates significant improvement compared to the natural history of untreated CTEPH. It's important to note that survival rates are generally highest in experienced centers with high procedural volumes and robust patient selection protocols.
While BPA is a lifesaving procedure for many, it is not without potential complications. These can range from minor to severe and include:
The incidence and severity of these complications have decreased with advancements in imaging, catheter technology, and operator expertise.
The success rate of BPA can be defined in several ways, often encompassing both procedural success and clinical improvement.
It's important to note that BPA is often performed in multiple sessions, targeting different segments of the pulmonary vasculature over time to achieve optimal results.
If you have not been diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) or do not have a referral for balloon pulmonary angioplasty, call (412) DOCTORS 412-362-8677 to schedule an appointment with a general cardiologist to be evaluated if this kind of procedure is needed.
