Pulmonary Hypertension

Rescue BPA Before Elective PEA + Mitral Valve Plasty in High-Risk Operable CTEPH

• Authors: Case authors
• Journal / date: Pulmonary Circulation, 2026
• DOI / URL: 10.1002/pul2.70308 | PMID 42051484 | PMC13112416
• Source basis: Full text (open access)
• Study type: Case report / strategy paper
• PH group: Group 4 (CTEPH with severe concomitant MR)
• Scenario: Operable CTEPH + severe MR causing refractory RHF; combined emergent PEA + mitral valve plasty was deemed unacceptably high-risk
• Strategy: Single BPA session with undersized balloons on a limited number of lesions, after confirming PAWP not elevated post-aggressive diuresis → stabilized RHF without precipitating pulmonary congestion → elective PEA + MVP weeks later with good outcome
• Why it matters (clinical takeaway):
• Adds a practical bridge option for operable CTEPH patients with severe LV-side pathology who are too sick for combined surgery upfront.
• Underscores the importance of measuring PAWP after aggressive decongestion before BPA in patients with mixed Group 4 + Group 2 physiology, to avoid post-BPA pulmonary edema.
• Sequencing (BPA → optimization → elective surgery) may convert a high-risk emergent case into a planned one — worth raising in CTEPH-MDT discussions.
• Caveats / limitations: Single case, no comparator. Approach requires a center with simultaneous BPA and PEA expertise.
• Referenced trials pulled forward: None.