Key result
Rescue BPA plus riociguat resolves NSPVT in a patient with hemodynamically unstable CTEPH.
Why the study?
Effective immediate treatment options for patients with inoperable CTEPH complicated by severe hemodynamic instability and NSPVT are not well established.
Does rescue balloon pulmonary angioplasty combined with riociguat therapy resolve nonsustained polymorphic ventricular tachycardia in a patient with hemodynamically unstable chronic thromboembolic pulmonary hypertension?
Case Report (n=1)
Does rescue balloon pulmonary angioplasty combined with riociguat therapy resolve nonsustained polymorphic ventricular tachycardia in a patient with hemodynamically unstable chronic thromboembolic pulmonary hypertension?
The combination of rescue balloon pulmonary angioplasty and riociguat therapy may be an effective immediate treatment for inoperable CTEPH presenting with severe hemodynamic instability and ventricular arrhythmias.
We encountered a case of frequent nonsustained polymorphic ventricular tachycardia (NSPVT) due to hemodynamically unstable chronic thromboembolic pulmonary hypertension (CTEPH). A 78-year-old woman was taking anticoagulants for CTEPH. She had refused specific treatment for CTEPH, including pulmonary vasodilators, because she was then asymptomatic. She fell and sustained a femoral neck fracture, and she was referred to our hospital in anticipation of a surgical repair. Her condition on admission was complicated by respiratory failure, and electrocardiogram monitoring showed frequent NSPVT. A right heart catheterization revealed high mean pulmonary artery pressure with severely reduced cardiac output. Pulmonary angiography showed bilateral stenosis and multiple obstructions. Because NSPVT was attributed to low cardiac output syndrome caused by CTEPH, rescue balloon pulmonary angioplasty (BPA) was performed, and riociguat treatment was initiated. Afterward, the NSPVT resolved. This case suggests that the combination of rescue BPA with riociguat therapy might be an immediate and effective treatment for patients with inoperable CTEPH and severe hemodynamic instability.
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Fukuda et al. (2023) conducted a case report in Chronic thromboembolic pulmonary hypertension with nonsustained polymorphic ventricular tachycardia (n=1). Rescue balloon pulmonary angioplasty and riociguat therapy was evaluated on Resolution of nonsustained polymorphic ventricular tachycardia. Rescue balloon pulmonary angioplasty combined with riociguat therapy successfully resolved nonsustained polymorphic ventricular tachycardia in a patient with hemodynamically unstable CTEPH.
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