Balloon Pulmonary Angioplasty (BPA)

What is a Balloon Pulmonary Angioplasty (BPA)?

Balloon Pulmonary Angioplasty (BPA) is a minimally invasive treatment for certain patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH). The basic principal is that by dilating the pulmonary arteries pulmonary perfusion and pressures may be improved, as a minimally invasive treatment option in patients who are not candidates for PTE. Dr. John Moriarty, who performs the BPA procedure at UCLA, is a nationally known interventional radiologist who is among a small group of experts in the world performing BPA.

Treatment Planning

All patients are evaluated by the UCLA Pulmonary Vascular Disease Team, including including Pulmonologists, Cardiothoracic surgeons and Interventional Radiologists. Comprehensive assessment of the patient including hemodynamic capacity, CT scans, nuclear medicine scans and medication is performed, and then suitable patients will be offered an angiogram. This is a test whereby dye is injected into the pulmonary arteries by a small catheter placed into the vein, and then live Xrays are taken to evaluate the flow and presence of clots and blockages. These images are then carefully reviewed by experts to evaluate whether the patient has “good target lesions” for BPA. If they exist, then the patient will be offered treatment. 

BPA Treatment

BPA is a minimally invasive, angiographic, procedure performed by an experienced physician team. It is performed under conscious sedation with additional anesthesia available if required. The vein in the thigh (right common femoral vein) is accessed and then a small catheter inserted. This is then guided through the heart to the pulmonary arteries of the lungs, and a target vessel accessed. Once position and safety is confirmed then the vessel is dilated with a balloon (angioplasty). This allows better flow to the lung, improving oxygenation and decreasing pressure. Frequently multiple areas within one lung are dilated at one time. The procedure usually takes 3-4 hours, and then the patient is transferred to our pulmonology floor for monitoring and care. The patient is monitored for any breathing or bleeding problems (which may rarely occur) and then returns for another procedure the day after with treatment of the other lung. The patient is then monitored and discharged the following day.

Following the set of procedures, the patient is followed in the Pulmonary Vascular Disease Clinic, and frequently will require several treatments of each lung before the BPA treatment cycle is complete.

Results of BPA

BPA improves pulmonary hemodynamics, as measured by mPAP, cardiac index (CI), PVR, brain natriuretic peptide (BNP), echocardiographic, magnetic resonance imaging and metrics of functional capacity, such as home oxygen requirement, NYHA/WHO functional class and 6MWD BPA also was associated with improved renal function, blood sugar control and nutritional status. These findings persisted after BPA with stable findings at 6 months or greater in various populations. Complications of BPA mostly involve vascular injury and reperfusion pulmonary edema which may manifest immediately or several days post-procedure.