Anesthetic considerations for balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: A narrative review

Chronic thromboembolic pulmonary hypertension develops in about 1–2 % of patients with pulmonary embolism. Pulmonary endarterectomy surgery is the treatment of choice. Approximately one third of patients are not candidates to undergo endarterectomy either because of imaging findings or associated comorbidities. Balloon pulmonary angioplasty is a percutaneous catheter-based procedure that has recently shown encouraging results with an acceptable safety profile for minimally invasive management of chronic thromboembolic pulmonary hypertension. This focused review provides an overview of chronic thromboembolic pulmonary hypertension as a disease process, as well as details regarding the balloon pulmonary angioplasty procedure as a treatment option. • Chronic thromboembolic pulmonary hypertension develops in about 1 % of patients with pulmonary embolism. • Pulmonary endarterectomy surgery is the treatment of choice. • Balloon pulmonary angioplasty is becoming common. • Monitored anesthesia care with light sedation is the optimal approach to maintain hemodynamic and pulmonary stability. • When complication occurs, treatment can range from vasoactive medications and positive pressure ventilation to mechanical circulatory support.