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Balloon pulmonary angioplasty in the treatment of chronic thromboembolic pulmonary hypertension: recent advances and future perspectives.

Chronic thromboembolic pulmonary hypertension is an important late sequela of pulmonary embolism. It is defined by precapillary pulmonary hypertension with mismatched perfusion defects and pulmonary arterial lesions after at least 3 months of effective anticoagulation. Symptomatic patients who do not have pulmonary hypertensionbut whofulfill all other criteria are diagnosed with chronic thromboembolic pulmonary disease.The treatment of chronic thromboembolic pulmonary hypertension is basedon three pillars: pulmonary endarterectomy, pulmonaryarterial hypertension-targeted medication,and balloon pulmonary angioplasty. Surgical pulmonary endarterectomy is the standard of care and can be performed in 2/3 of all patients.Targeted medication with or without balloon pulmonary angioplasty is reserved for inoperable patients or patients with residual pulmonary hypertension after surgical treatment. Despite alack of profound evidence, the treatment of chronic thromboembolic pulmonary disease is similarto that of patients with pulmonary hypertension: pulmonary endarterectomy is offered to operable patients, whereas balloon pulmonary angioplasty is considered for inoperable patients.Since therapeuticstrategies are complex,and diagnostic as well as therapeutic procedures are demanding,treatment in a specialized, experienced center is mandatory.