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Case Reports
. 2022 May 27;12(2):e12064.
doi: 10.1002/pul2.12064. eCollection 2022 Apr.

An unusual case of CTEPH treated by BPA in a patient with a single lung after cancer surgery

Szymon Darocha  1 , Paweł Kurzyna  2 , Marta Banaszkiewicz-Cyganik  1 , Piotr Kędzierski  1 , Michał Florczyk  1 , Arkadiusz Pietrasik  2 , Dariusz Zieliński  3 , Andrzej Biederman  3 , Adam Torbicki  1 , Marcin Kurzyna  1
Affiliations
Case Reports

An unusual case of CTEPH treated by BPA in a patient with a single lung after cancer surgery

Szymon Darocha et al. Pulm Circ. .

Abstract

A 46-year-old man 1 year after left-sided pneumonectomy for squamous cell lung cancer presented with severely limited exercise tolerance and dyspnea corresponding to World Health Organization functional class IV (WHO Class IV). After right heart catheterization (RHC), mean pulmonary artery pressure (mPAP) was 43 mmHg and pulmonary vascular resistance (PVR) was 10.2 Wood units (WU). Arteriography revealed organized clots located at the proximal level of the right pulmonary artery, leading to a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). The CTEPH team disqualified the patient from surgical treatment due to high perioperative risk and referred him for balloon pulmonary angioplasty (BPA) together with pulmonary hypertension-specific pharmacotherapy (sildenafil). The patient underwent a cycle of nine BPA sessions and completed treatment without complications. Follow-up showed sustained hemodynamic improvement in RHC (mPAP 23 mmHg, PVR 2.6 WU), improved physical capacity (WHO Class II), and relief of dyspnea symptoms.

Keywords: balloon pulmonary angioplasty; chronic thromboembolic pulmonary hypertension; lung cancer; single lung.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Computed tomography showing reduced chest capacity due to left‐sided pneumonectomy (arrow). (b) Pulmonary angiography was performed before the first BPA session, showing an amputated right lower‐lobe artery (arrow). (c) Computed tomography was performed before the first BPA session, showing proximal occlusion of the right pulmonary artery (arrow). (d) Angiography was performed after the last BPA session with the improvement of distal perfusion. BPA, balloon pulmonary angioplasty.
See this image and copyright information in PMC

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