Successful right heart remodelling and subsequent pregnancy in a patient with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty: a case report

Two pregnancies in a patient following pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

Pregnancies complicated by pulmonary hypertension are associated with a high rate of maternal morbidity and mortality. Pulmonary endarterectomy is a curative treatment for pulmonary hypertension in select patients with chronic thromboembolic pulmonary hypertension. Limited data exist regarding the maternal and perinatal outcomes following pulmonary endarterectomy.We present the case of a patient in her 20s with antiphospholipid antibody syndrome and chronic thromboembolic pulmonary hypertension who underwent pulmonary endarterectomy and subsequently carried two pregnancies. Her cardiopulmonary status remained stable throughout both pregnancies. Her first pregnancy was complicated by HELLP syndrome requiring induction of labour at 30 weeks, and her second child was born at term. In summary, this patient's course provides cautious optimism that a curative pulmonary endarterectomy may allow a patient to avoid complications of pulmonary hypertension during pregnancy.

Preprocedural frailty is strongly associated with symptoms after balloon pulmonary angioplasty

Balloon pulmonary angioplasty (BPA) has improved the survival rate of patients with chronic thromboembolic pulmonary hypertension (CTEPH). The resolution of symptoms is one of the remaining goals of BPA. Frailty affects the outcome of cardiovascular diseases or treatments. The aim of this study is to assess the association between frailty and outcome of BPA. The resolution of symptoms is evaluated by the post-BPA World Health Organization functional class (WHO-FC). A total of 54 patients with CTEPH were divided into 2 groups by post-BPA WHO-FC (WHO-FC I group; n = 34 vs. WHO-FC ≥ II group; n = 20). Frailty was assessed by physicians using the clinical frailty scale (CFS) at the point of patient admission for their first BPA sessions. Compared to the WHO-FC ≥ II group, the WHO-FC I group was younger (65.6 ± 13.9 years vs. 74.3 ± 8.0 years) and had a lower CFS (3 [3, 4] vs. 4 [4, 6]) (median [25th, 75th percentiles]). The WHO-FC I achievement rates for each CFS score were CFS 3: 82.8%; 4: 53.8%; 5: 25.0%; 6: 33.3%; and 7: 20.0%. Logistic regression analysis showed that CFS was an independent predictor of WHO-FC I achievement (odds ratio 0.50, p = 0.012), but pre-BPA hemodynamic parameters and age were not independent predictors. Whether WHO-FC I can be achieved is predicted by pre-BPA patient frailty but not by pre-BPA hemodynamic parameters and age.

Pregnancy in a Patient With Chronic Thromboembolic Pulmonary Hypertension After Successful Treatment with Balloon Pulmonary Angioplasty

Pulmonary hypertension has been recognized as a contraindication to pregnancy. Recently, several groups have shown promising results with the use of balloon pulmonary angioplasty (BPA) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) patients with distally located organized thrombi who were not candidates for pulmonary endarterectomy. We present the case report of a 26-year-old woman who became pregnant after successful treatment of severe CTEPH with the use of BPA. We conclude that patients undergoing effective BPA for CTEPH can consider becoming pregnant if followed closely by a multidisciplinary team, including experts in thrombosis, pulmonary hypertension, and obstetrics.