Predictive value of left ventricular ejection fraction for the occurrence of postoperative myocardial infarction after coronary endarterectomy in patients with diffuse coronary artery disease / 中华心血管病杂志

Objective: To investigate the predictive value of ejection fraction for the postoperative myocardial infarction after coronary endarterectomy (CE) in patients with diffuse coronary artery disease (DCAD). Methods: Patients who underwent cardiac artery bypass graft (CABG) surgery and CE in Beijing Anzhen Hospital affiliated to Capital Medical University from May 2018 to December 2020 were enrolled in this prospective observational study. Baseline features including age, sex and echocardiography parameters were obtained. Left ventricular ejection fraction(EF) was measured by echocardiography. The patients were divided into postoperative myocardial infarction (PMI) group and non-PMI group according to PMI occurrence. Linear regression analysis, logistic regression model, and receiver operating characteristic(ROC) curve were used to analyze the correlation between left ventricular ejection fraction and PMI and the influencing factors. Results: A total of 120 patients were enrolled in the study. There were 32 patients (27%) in the PMI group (male 27(84%), age (62±8)), inferior myocardial infarction occurred in 24 (75%) patients. There were 88 patients (73%) in the non-PMI group (male 70(80%), age (62±8)). EF (55% (49%, 64%) vs. 62% (55%, 67%), P=0.01) was significantly lower in the PMI group than in the non-PMI group. Perioperative TNI, IABP use and length of hospitalization were significantly higher in the PMI group than in the non-PMI group. Multivariate logistic regression showed that lower EF was an independent risk factor of PMI (OR=0.93, 95%CI: 0.89-0.98, P=0.01) after adjusting age, sex and body mass index. ROC curve analysis showed that EF<60% could sufficiently predict the occurrence of PMI (AUC= 0.67, sensitivity 64%, specificity 69%, P=0.01). Linear regression analysis showed that left ventricular end-diastolic diameter (OR=-0.52, 95%CI:-1.13-0.60, P<0.001), graft flow in left anterior descending (OR=-0.20, 95%CI:-0.15-0.01, P=0.02) and history of diabetes (OR=-0.28, 95%CI:-8.25-1.85, P=0.002) were negatively correlated with preoperative EF value. Conclusion: Lower preoperative EF is an independent risk factor for PMI after CABG and CE in DCAD patients, closely related to the left ventricular end-diastolic diameter, graft flow in left anterior descending artery and diabetes mellitus.

Tratamento combinado na dissecção de artéria mesentérica superior: desafio terapêutico / Combination treatment for superior mesenteric artery dissection: therapeutic challenge

Resumo A dissecção da artéria mesentérica superior é uma causa rara de dor abdominal, com quadro clínico variável. Seu diagnóstico é difícil, e não existe consenso sobre suas opções terapêuticas; elas variam em torno de tratamento conservador, correção aberta, endovascular ou combinada. Descrevemos o caso de um homem de 45 anos com dissecção isolada da artéria mesentérica superior, com quadro de dor abdominal persistente após tentativa de tratamento conservador. Ele foi submetido à revascularização cirúrgica aberta devido à localização e complexidade da dissecção. O tratamento com endarterectomia, arterioplastia com remendo de pericárdio bovino e acesso retrógrado para abertura da mesentérica com stent foi realizado com sucesso. A angina abdominal foi totalmente resolvida após estabilização do quadro. A combinação de abordagem aberta e endovascular deve ser considerada como terapia para casos de dissecção complexa isolada da artéria mesentérica superior.

Abstract Dissection of the superior mesenteric artery is a rare cause of abdominal pain, with a variable clinical picture. It is difficult to diagnose and there is no consensus on treatment options, which range from conservative treatment to open, endovascular, or combination repair. We describe the case of a 45-year-old man with isolated dissection of the superior mesenteric artery and persistent abdominal pain after conservative treatment had been attempted. He underwent open surgical revascularization due to the location and complexity of the dissection. Treatment consisting of endarterectomy, arterioplasty with bovine pericardium patch, and retrograde access to open the mesenteric artery with a stent was successful. Abdominal angina was completely resolved after the condition had stabilized. A combination of open and endovascular approaches should be considered as treatment for cases of isolated complex dissection of the superior mesenteric artery.

Profundaplastia femoral como un proceder inusual en la "era endovascular" / Femoral deep plasty as an unfrequent procedure in the "endovascular era"

Introducción: La arteria femoral común y sus ramas suministran la mayor parte del flujo sanguíneo al muslo, así como a la totalidad de la pierna y el pie, lo que da lugar a la mayor rama del triángulo femoral: la arteria femoral profunda. Objetivo: Exponer la efectividad de la profundaplastia femoral en la "era endovascular". Reporte del caso: Se presenta un caso de enfermedad arterial periférica de múltiples sectores, sin criterio de cirugía revascularizadora (derivación protésica aorto bifemoral). El paciente manifestaba claudicación intermitente a menos de 30 metros, localizada en pantorrilla derecha. En el estudio hemodinámico se apreciaron los índices de presiones tobillo/brazo disminuidos en arteria tibial posterior (0,46) y pedia derecha (0,33). La ecografía doppler del sector femoral derecho evidenció una estenosis de la arteria femoral profunda en su origen, que producía aumento de las velocidades picos sistólicos (479 cm/s), con flujo desorganizado, dilatación posestenótica y oclusión de la arteria femoral superficial en su origen. Se realizó endarterectomía femoral común y profunda con colocación de parche de politetrafloroetileno. El paciente evolucionó sin complicaciones posoperatorias. En el seguimiento se observó mejoría clínica en relación con la distancia de claudicación y un aumento de los índices de presiones tobillo/brazo en arteria tibial posterior y pedia derecha (0,50), respectivamente. Conclusiones: La profundaplastia femoral, aún en la "era endovascular", permanece como un proceder eficaz que resulta alternativa de tratamiento revascularizador en la enfermedad arterial periférica de localización infrainguinal(AU)

Introduction: The normal femoral artery and its branches supply most of the blood flow to the thigh, as well as to the whole leg and foot, which forms the largest branch of the femoral triangle: the deep femoral artery. Objective: Show the effectiveness of femoral deep plasty in the "endovascular era". Case report: It is presented a case of peripheral artery disease in multiple sectors, without surgical criteria of revascularization (derivación protésica aortobifemoral). The patient presented intermittent claudication in less than 30 meters, and it was located in the right calf. In the hemodynamic study, the ankle-arm pressure indexes were dicreased in the posterior tibial artery (0,46) and right dorsalis pedis artery (0,33). The doppler echocardiography of the right femoral sector confirmed a stenosis in the deep femoral artery in its origin, which produced an increase in the peak systolic velocity (479 cm/s), unorganized flows, poststenotic dilatation and occlusion of the superficial femoral artery in its origin. It was performed a common and deep femoral endarterectomy with colocation of polytetrafluoroethylene patch. The patient evolved without post-surgical complications. In the follow-up, it was observed a clinical improvement in relation with the claudication distance and the increase of the ankle-arm pressure indexes in the posterior tibial artery and right dorsalis pedis artery (0,50), respectively. Conclusions: The femoral deep plasty, still in the ´´endovascular era´´, is an efficient procedure that is an alternative to the revascularization treatment in the peripheral artery disease with infrainguinal location(AU)

Endarterectomía carotídea como procedimiento quirúrgico de obstrucción y/o estenosis de arteria carótida interna / Carotid endarterectomy as a surgical procedure of carotid obstruction and/or stenosis

La endarterectomía carotídea es el procedimiento quirúrgico de elección para tratar la obstrucción y/o estenosis de la arteria carótida extracraneal y prevenir los eventos neurológicos. La aparición de síntomas depende de la gravedad y progresión de la lesión, del adecuado flujo colateral, de las características de la placa y de la presencia de otros factores de riesgo. Analizamos el resultado de la endarterectomía carotídea como procedimiento quirúrgico de elección para la estenosis carotídea, así como la presentación de un caso clínico de un adulto mayor con oclusión del 100% y la resolución completa de los síntomas posteriores al procedimiento quirúrgico (AU)

Endarterectomy of the carotid is the surgical procedure of choice to treat obstruction and/or stenosis of the extracranial carotid artery and prevent neurological events. The appearance of symptoms depends on the severity and progression of the lesion, the adequate collateral flow, the characteristics of the plaque and the presence of other risk factors. We analyze the result of carotid endarterectomy as the surgical procedure of choice for carotid stenosis as well as the presentation of a clinical case of an elderly adult patient with 100% occlusion and complete resolution of symptoms after the surgical procedure (AU)

Chronic thromboembolic pulmonary hypertension: the impact of advances in perioperative techniques in patient outcomes / Hipertensão pulmonar tromboembólica crônica: o impacto dos avanços nas técnicas perioperatórias nos resultados dos pacientes

ABSTRACT Objectives Pulmonary endarterectomy (PEA) is the gold standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed at reporting outcomes of CTEPH patients undergoing PEA within 10 years, focusing on advances in anesthetic and surgical techniques. Methods We evaluated 102 patients who underwent PEA between January 2007 and May 2016 at the Instituto do Coração do Hospital das Clínicas da Universidade de São Paulo. Changes in techniques included longer cardiopulmonary bypass, heating, and cooling times and mean time of deep hypothermic circulatory arrest and shortened reperfusion time. Patients were stratified according to temporal changes in anesthetic and surgical techniques: group 1 (January 2007-December 2012), group 2 (January 2013-March 2015), and group 3 (April 2015-May 2016). Clinical outcomes were any occurrence of complications during hospitalization. Results Groups 1, 2, and 3 included 38, 35, and 29 patients, respectively. Overall, 62.8% were women (mean age, 49.1 years), and 65.7% were in New York Heart Association functional class III-IV. Postoperative complications were less frequent in group 3 than in groups 1 and 2: surgical complications (10.3% vs. 34.2% vs. 31.4%, p=0.035), bleeding (10.3% vs. 31.5% vs. 25.7%, p=0.047), and stroke (0 vs. 13.2% vs. 0, p=0.01). Between 3 and 6 months post-discharge, 85% were in NYHA class I-II. Conclusion Improvements in anesthetic and surgical procedures were associated with better outcomes in CTEPH patients undergoing PEA during the 10-year period.

RESUMO Objetivo A endarterectomia pulmonar (EAP) é o tratamento padrão ouro para hipertensão pulmonar tromboembólica crônica (HPTEC). O objetivo deste estudo foi relatar a evolução de pacientes com HPTEC submetidos a EAP em 10 anos, com foco nos avanços nas técnicas anestésicas e cirúrgicas. Métodos Foram avaliados 102 pacientes submetidos à EAP entre janeiro de 2007 e maio de 2016 no Instituto do Coração do Hospital das Clínicas da Universidade de São Paulo. Mudanças nas técnicas incluíram circulação extracorpórea, tempos de aquecimento e resfriamento mais longos e tempo médio de hipotermia profunda com parada circulatória e tempo de reperfusão reduzido. Os pacientes foram estratificados de acordo com as mudanças temporais nas técnicas anestésicas e cirúrgicas: grupo 1 (janeiro de 2007 a dezembro de 2012), grupo 2 (janeiro de 2013 a março de 2015) e grupo 3 (abril de 2015 a maio de 2016). Os desfechos clínicos foram qualquer ocorrência de complicações durante a hospitalização. Resultados Os grupos 1, 2 e 3 incluíram 38, 35 e 29 pacientes, respectivamente. No geral, 62,8% eram mulheres (idade média, 49,1 anos) e 65,7% estavam em classe funcional III-IV da New York Heart Association. As complicações pós-operatórias foram menos frequentes no grupo 3 do que nos grupos 1 e 2: complicações cirúrgicas (10,3% vs. 34,2% vs. 31,4%, p=0,035), sangramento (10,3% vs. 31,5% vs. 25,7%, p=0,047) e acidente vascular cerebral (0 vs. 13,2% vs. 0, p=0,01). Entre 3 e 6 meses após a alta, 85% estavam na classe I-II da NYHA. Conclusão Melhorias nos procedimentos anestésicos e cirúrgicos foram associadas a melhores resultados em pacientes com HPTEC submetidos a EAP durante o período de 10 anos.

Hipertensión pulmonar crónica tromboembólica tromboendarterectomía pulmonar / Chronic thromboembolic pulmonary hypertension

A nivel mundial, la tercera causa de muerte por causa cardiovascular es el Tromboembolismo Pulmonar (TEP), después del Infarto agudo de Miocardio y el Accidente cerebrovascular, con una incidencia anual estimada de 40 casos por cada 100.000 habitantes. Se comunica el caso clínico de un paciente de 44 años con diagnóstico de TEP recurrente con Hipertensión pulmonar tromboembólica crónica (CTPH) que fue sometido a tromboendarterectomía pulmonar bilateral (PTE) bajo paro circulatorio con hipotermia profunda. Se informa de los resultados de los medios de diagnóstico y del tratamiento quirúrgico mediante la tromboendarterectomía. Se discute el tema en el contexto de la experiencia internacional y nacional.

Coronary endarterectomy: a case control study and evaluation of early patency rate of endarterectomized arteries

Abstract Objective: To compare two groups of patients - the coronary endarterectomy group, with patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy (CE), and the control group, with patients undergoing CABG without CE. We analyzed the rate of major outcomes (perioperative acute myocardial infarction [AMI], stroke, and mortality) and minor outcomes (time of cardiopulmonary bypass [CPB], time of aortic clamp, and postoperative length of hospital stay). We also determined the rates of early graft patency in patients undergoing CE. Methods: We reviewed a database of patients submitted to CABG, with or without associated CE, between January 2011 and June 2017. Twenty-five patients submitted to CE were compared with 201 patients submitted only to conventional surgery; the two groups presented similar preoperative characteristics and all the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II variables did not presented statistically significant difference. We considered statistically significant values of P< 0.05. Results: There was no statistically significant difference in relation to time of post-surgical hospitalization (P=0.8139), incidence of perioperative AMI (P=0.2976), stroke (P=0,2976), and mortality rate (P=1.0000), but endarterectomy was associated with longer aortic clamping time (P=0.0004) and CPB time (P=0.0030). The rate of patency evaluated in patients submitted to endarterectomy (78,95%) was compatible with that described in the literature. Conclusion: In this sample, coronary endarterectomy was associated with the rate of early graft patency similar to that of the literature, with morbidity and mortality rates similar to those of conventional surgery.

Anesthesia management for a patient undergoing pulmonary endarterctomy without cardiopulmonary bypass

Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperative anesthesia and surgical management of pulmonary endarterectomy which was successfully managed without Cardiopulmonary Bypass.

Embolia pulmonar tumoral: un reto diagnóstico / Pulmonary tumour embolism: a diagnostic challenge

Resumen Se publica el caso de una paciente de 27 años, quien consultó al Servicio de Urgencias del Hospital Hernando Moncaleano Perdomo, por cuadro clínico de tos seca persistente que posteriormente se acompañó de disnea, dolor pleurítico y hemoptisis, de aproximadamente cuatro meses de evolución. Tenía antecedentes quirúrgicos de lipoescultura y abdominoplastia cuatro meses previos al ingreso e histerectomía hace un año (por hemorragia uterina). Mediante correlación clínico-patológica se llegó al diagnóstico de embolia pulmonar de origen tumoral, entidad aún de diagnóstico difícil dada la presentación clínica inespecífica. Para la diferenciación diagnóstica los estudios radiológicos no son precisos, a menos que se lleven a cabo procedimientos invasivos para llegar a un diagnóstico certero, como ocurrió con la paciente. Se presenta el caso y se hace una revisión sobre embolia pulmonar y sus otras causas como coriocarcinoma; adicionalmente se abarcan aspectos relevantes sobre incidencia, cuadro clínico, tratamiento y pronóstico, de una patología cuyo diagnóstico sigue siendo en su mayoría tardío.

Abstract The case is presented of a 27 year-old patient who was seen in the Emergency Department of the Hospital Hernando Moncaleano Perdomo, due to a clinical picture of a persistent dry cough that was later accompanied by dyspnoea, pleural pain, and haemoptysis, of approximately four months onset. She had a surgical history of liposculpture and abdominoplasty four months prior to the admission, and a hysterectomy a year ago (uterine haemorrhage). Using clinical-pathological correlation, the diagnosis was made of a pulmonary embolism of tumour origin, a condition still difficult to diagnose given the unspecific clinical picture. Radiological studies are not accurate for the differential diagnosis, unless invasive procedures are used to reach an accurate diagnosis, as in the case of this patient. As well as the case, a review is presented on pulmonary embolism and its other causes such as choriocarcinoma. Furthermore, relevant aspects are included on its incidence, clinical symptoms, treatment and prognosis, in a disease for which the majority of diagnoses continue to be delayed.

Outcomes of Carotid Endarterectomy according to the Anesthetic Method: General versus Regional Anesthesia / 대한흉부외과학회지

BACKGROUND: The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA).METHODS: Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patients underwent CEA under RA with cervical plexus block, whereas 30 patients underwent CEA under GA. In the RA group, a carotid shunt was selectively used for patients who exhibited negative results on the awake test. In contrast, such a shunt was used for all patients in the GA group.RESULTS: There were no cases of postoperative stroke, cardiovascular events, or mortality. Nerve injuries were noted in 4 patients (3 in the RA group and 1 in the GA group), but they fully recovered prior to discharge. Operative time and clamp time were shorter in the RA group than in the GA group (119.29±27.71 min vs. 161.43±20.79 min, p<0.001; 30.57±6.80 min vs. 51.77±13.38 min, p<0.001, respectively). The hospital stay was shorter in the RA group than in the GA group (14.6±5.05 days vs. 18.97±8.92 days, p=0.022). None of the patients experienced a stroke or restenosis during the 27.23±20.3-month follow-up period.CONCLUSION: RA with a reliable awake test reduces shunt use and decreases the clamp and operative times of CEA, eventually resulting in a reduced length of hospital stay.

Chronic Thromboembolic Pulmonary Hypertension: Endovascular Treatment

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare cause of pulmonary hypertension; less than 5% of pulmonary hypertension is caused by recurrent pulmonary thromboembolism (PTE). By definition, CTEPH happens within the first two years after symptomatic PTE; however, cases are often diagnosed without a history of acute PTE. Because of the poor functional status and chronicity of this disease, the classic and curative strategy of open pulmonary endarterectomy cannot be applied in some patients with lesions that involve the distal subsegmental pulmonary artery. Bridging therapy is needed for cases that are technically operable but have an unacceptable risk-benefit assessment or residual symptomatic pulmonary hypertension following surgical removal. Groups in Europe and Japan recently introduced balloon pulmonary angioplasty or percutaneous transluminal pulmonary angioplasty, which has led to significant improvement in functional and hemodynamic parameters in patients with CTEPH. This article introduces recent updates in patient selection and interventional procedures for this chronic and devastating disease.

Silent Intracerebral Hemorrhage in Patients Randomized to Stenting or Endarterectomy for Symptomatic Carotid Stenosis / 대한뇌졸중학회지

No abstract available.

Endovascular Repair of an Iliac Artery Pseudoaneurysm Using a Surgeon-Reconstructed Prosthetic Graft and a Bare Metal Stent

Iliac artery aneurysms are usually asymptomatic. Herein, we report a novel strategy for the repair of a pseudoaneurysm involving the external iliac artery using a conventional artificial graft and bare metal stent. A 76-year-old male patient presented with severe resting pain and right foot discoloration. Computed tomography angiography revealed a right distal external iliac artery pseudoaneurysm, with severe calcified occlusion at the right common and superficial femoral arteries. After exposing the right femoral artery, long-segment endarterectomy and patch angioplasty with the ipsilateral greater saphenous vein were performed. Before the completion of patch angioplasty, a surgeon-modified 8-mm expanded polytetrafluoroethylene (ePTFE) graft was inserted for complete pseudoaneurysm repair. If a commercial covered stent is not available, minimally invasive endovascular repair can be safely performed using a surgeon-modified ePTFE graft and bare metal stent.

Aortic Arch Endarterectomy Associated with On-Pump Cardiac Surgery in Patients with a Mobile Arch Atheroma / 대한흉부외과학회지

We describe aortic arch endarterectomy performed concomitantly with on-pump cardiac surgery in 2 patients with grade V arch atherosclerosis. In both patients, transesophageal echocardiographic findings led to the diagnosis of severe arch atherosclerosis associated with a mobile atheromatous plaque in the aortic arch. The severe arch atherosclerosis was managed with endarterectomy under deep hypothermic circulatory arrest. In patients with severe grade V atherosclerosis in the aortic arch, performing endarterectomy simultaneously with primary cardiac surgery may be justified as a way to reduce the risk of peripheral embolism, including cerebrovascular accidents, with minimal additional surgical risk.

Comparison of Long Term Prognosis between Carotid Endarterectomy versus Stenting; A Korean Population-Based Study Using National Insurance Data / 신경중재치료의학

PURPOSE: Although carotid endarterectomy (CEA) is recommended as a treatment for carotid stenosis rather than carotid artery stenting (CAS), CAS has been preferred in Korea. The aim of this study was to analyze long-term outcomes after CAS compared with CEA using Korean nationwide insurance data. MATERIALS AND METHODS: We obtained all data from the nationwide database of the Health Insurance Review & Assessment Service (HIRA) during the study period using several codes regarding the procedure or operation. We included the HIRA data, which included at least one-year follow-up after the procedures. The outcomes associated with both procedures were death, recurrence of ischemic stroke, and admission for cerebral hemorrhage. RESULTS: A total of 16,065 eligible patients who were treated with CAS or CEA between 1 January 2007 and 31 December 2016 were analyzed. The number of patients with CAS and CEA was 12,173 (75.8%) and 3,892 (24.2%), respectively. 8,976 patients (55.9%) were classified as symptomatic patients. CAS was associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.282; 95% confidence interval [CI], 1.173–1.400). The adjusted rates for recurrent ischemic stroke and cerebral hemorrhage between CAS versus CEA were 24.9% versus 15.9% (HR, 1.474; 95% CI, 1.325–1.639) and 1.5% versus 0.9% (HR, 2.026; 95% CI, 1.322–3.106), respectively. In young symptomatic patients, there was no statistically significant difference in all-cause mortality and cardiovascular death between CAS and CEA. CONCLUSION: Our study using Korean nationwide insurance data demonstrated similar results to previous studies. Until further evidence of CAS is established through prospective studies, CAS should be performed in selected patients according to current guidelines.

Angioplastia percutánea con balón en hipertensión pulmonar tromboembólica crónica / Percutaneous balloon angioplasty for treatment of chronic thromboembolic pulmonary hypertension

La hipertensión pulmonar tromboembólica crónica se caracteriza por la presencia de material trombótico organizado dentro de las arterias pulmonares que genera elevación de la resistencia vascular pulmonar, insuficiencia cardíaca derecha y, eventualmente, la muerte. El tratamiento de elección es la tromboendarterectomía pulmonar, que suele ser curativa si la obstrucción es proximal. En algunos casos este tratamiento no es posible y surge como alternativa la angioplastia pulmonar con balón (APB), que está generando creciente interés. Se presentan tres casos de pacientes con hipertensión pulmonar tromboembólica a los que por diferentes circunstancias no pudo tratarse con tromboendarterectomía y se realizó APB comprobándose, en los tres casos, mejoría de la clase funcional, prueba de la caminata de seis minutos, además de parámetros hemodinámicos y angiográficos.

Chronic thromboembolic pulmonary hypertension is characterized by the presence of organized thrombotic material in the pulmonary arteries which causes elevation of the pulmonary vascular resistance, right heart failure, and death if not treated. Pulmonary thromboendarterectomy is the treatment of choice and can be curative when the obstruction is proximal. There are cases in which this therapy is not possible, and pulmonary angioplasty is a therapeutic alternative of growing interest. We present our experience with three patients diagnosed with chronic thromboembolic pulmonary hypertension in whom pulmonary endarterectomy was not possible and pulmonary angioplasty was performed. All patients showed improvement of functional class, six-minute walk distance, and hemodynamic as well as angiographic parameters.