Long‐Term Supervised Cardiac Rehabilitation After Balloon Pulmonary Angioplasty Improved Residual Exercise Pulmonary Hypertension in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Two‐Case Report

Abnormal pulmonary hemodynamics during exercise may persist even after balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). We report two female patients who underwent long‐term supervised outpatient cardiac rehabilitation (CR) after BPA with continuous pulmonary vasodilators. In Case 1, training was performed at an intensity close to the anaerobic threshold. In Case 2, high‐intensity interval training (HIIT) was gradually introduced. Exercise right heart catheterization was used for serial assessment of the mean pulmonary arterial pressure/cardiac output slope (mPAP/CO slope). Functional outcomes were also evaluated by cardiopulmonary exercise testing. No adverse events occurred during follow‐up. The mPAP/CO slope improved from 6.28 to 4.06 mmHg/L/min at 12 months in Case 1 and from 8.40 to 6.71 mmHg/L/min at 18 months in Case 2. Peak VO 2 also increased from 16.2 to 20.2 mL/kg/min in Case 1 and from 18.3 to 24.9 mL/kg/min in Case 2. Long‐term supervised outpatient CR after BPA appears to be feasible and may improve exercise pulmonary hemodynamics and exercise capacity.