Name of the Procedure

Percutaneous Transluminal Pulmonary Artery Balloon Angioplasty (PTPABA); Single Vessel

Summary

Percutaneous Transluminal Pulmonary Artery Balloon Angioplasty (PTPABA) is a minimally invasive procedure to open up narrowed or blocked pulmonary arteries. A balloon-tipped catheter is inserted through the skin and guided to the affected artery, where the balloon is inflated to widen the artery and improve blood flow.

Purpose

This procedure is used to treat pulmonary artery stenosis, a condition where the arteries carrying blood from the heart to the lungs become narrowed or blocked. The goal is to improve blood flow, reduce symptoms like shortness of breath, and prevent complications such as pulmonary hypertension.

Indications

• Pulmonary artery stenosis
• Symptoms like dyspnea (shortness of breath), fatigue, or chest pain
• Evidence of decreased blood flow to the lungs on imaging studies
• Patients who are not candidates for surgical intervention or prefer a less invasive option

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustments to current medications as instructed by the healthcare provider
• Pre-procedure imaging tests such as echocardiography or CT angiography to assess the pulmonary arteries' condition
• Blood tests to check clotting function and overall health

Procedure Description

1. The patient lies on an X-ray table, and local anesthesia is applied to the insertion site, usually the groin or arm.
2. A small incision is made, and a catheter is inserted into a blood vessel.
3. Using imaging guidance, the catheter is navigated to the pulmonary artery.
4. Once in position, a balloon at the catheter's tip is inflated to expand the narrowed section of the artery.
5. The balloon is deflated and removed, and the catheter is withdrawn.
6. The insertion site is closed with manual pressure or a closure device.

Tools and equipment: Catheter, balloon-tipped device, X-ray imaging equipment.

Anesthesia: Local anesthesia with possible sedation.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

Performed in a hospital's catheterization laboratory or specialized outpatient clinic with appropriate facilities.

Personnel

• Interventional cardiologist or radiologist performing the procedure
• Nurses assisting with preparation and monitoring
• Anesthesiologist or nurse anesthetist if sedation is provided
• Technicians operating imaging equipment

Risks and Complications

• Common risks: Bruising or bleeding at the insertion site, discomfort, or transient chest pain
• Rare risks: Blood vessel damage, blood clots, infection, adverse reaction to contrast dye, and complications requiring emergency surgery
• Management: Close monitoring during and after the procedure, use of anticoagulants if necessary, and prompt treatment of any complications

Benefits

• Improved blood flow to the lungs
• Reduced symptoms such as shortness of breath and fatigue
• Non-surgical, minimally invasive approach with a relatively short recovery time
• Immediate improvement in vessel patency often observed

Recovery

• Post-procedure monitoring in a recovery area for several hours
• Instructions to avoid strenuous activities for a few days
• Keeping the insertion site clean and dry to prevent infection
• Follow-up appointments for imaging studies and assessment of the procedure's success

Alternatives

• Medication management to alleviate symptoms
• Surgical options such as pulmonary artery bypass grafting or endarterectomy
• Pros and cons: Medications may not be as effective in significant stenosis, and surgery involves a longer recovery time and higher risk compared to balloon angioplasty

Patient Experience

• During the procedure: Minimal discomfort due to local anesthesia, mild pressure when the balloon is inflated
• After the procedure: Mild soreness at the insertion site, usual daily activities can generally be resumed within a few days
• Pain management: Over-the-counter pain relief if necessary and comfort measures including rest and hydration