Advances in Balloon Pulmonary Angioplasty for the Treatment of Chronic Thromboembolic Pulmonary Hypertension
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摘要: 慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension, CTEPH)是一种慢性致死性疾病, 由机化的血栓引起肺动脉狭窄或阻塞、血流重新分布以及肺微血管床重构, 导致肺动脉压力和肺血管阻力进行性升高, 最终引发患者右心衰竭甚至死亡。肺动脉血栓内膜剥脱术(pulmonary endarterectomy, PEA)被认为是CTEPH的首选治疗方法, 然而约40%的CTEPH患者由于远端病变或术后出现肺动脉高压无法进行PEA手术。球囊肺动脉成形术(balloon pulmonary angioplasty, BPA)是在血管造影引导下使用合适大小的球囊逐级扩张并打开狭窄或闭塞肺血管的导管介入技术, 可为无法接受PEA手术的CTEPH患者提供新的治疗选择。本文就BPA临床治疗及术后并发症的预测、BPA与PEA联合治疗、BPA与利奥西呱联合治疗等方面的最新研究进展作一综述, 以期为CTEPH患者临床治疗方案的选择提供参考。
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关键词:
- 慢性血栓栓塞性肺动脉高压 /
- 球囊肺动脉成形术 /
- 肺动脉内膜剥脱术 /
- 利奥西呱
Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic life-threatening disease caused by organized blood clots that narrow or block the pulmonary arteries, leading to redistributions of blood flow and remodeling of the pulmonary microvascular bed. This progressive increase in pulmonary vascular resistance and pulmonary arterial pressure eventually results in right heart failure or even death. Pulmonary endarterectomy (PEA) is considered the preferred treatment for CTEPH. However, approximately 40% of patients are unable to undergo PEA surgery due to distal lesions or complications. Balloon pulmonary angioplasty (BPA) is an angiographically guided catheter intervention that uses appropriately sized balloons to dilate and open narrowed or occluded pulmonary vessels step by step. BPA holds great promise for offering a new treatment option for these patients. This article reviews the clinical efficacy and predictability of postoperative complications of BPA in treating CTEPH, as well as the advances in combined treatment of BPA with PEA or with riociguat, with the aim to provide reference for clinicians in selecting treatment options for CTEPH patients.作者贡献:高璐阳负责文献检索及论文撰写;罗勤、赵智慧、赵青负责论文修订;柳志红负责提供论文写作思路。利益冲突:所有作者均声明不存在利益冲突 -
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