{"id":72056,"date":"2023-10-09T09:33:53","date_gmt":"2023-10-09T15:33:53","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=72056"},"modified":"2023-10-09T09:33:53","modified_gmt":"2023-10-09T15:33:53","slug":"regions-first-balloon-pulmonary-angioplasty-program","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/regions-first-balloon-pulmonary-angioplasty-program\/","title":{"rendered":"Region\u2019s first balloon pulmonary angioplasty program puts more air in the lungs of CTEPH patients"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><figure id=\"attachment_72059\" aria-describedby=\"caption-attachment-72059\" style=\"width: 640px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-72059\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2023\/10\/05123305\/Connie-Jim-Starr-Memorial-Parksized.webp\" alt=\"Connie and husband Jim Starr at Memorial Park in Woodland Park, Colo. Connie, who had previously undergone surgery to remove blood clots in major lung arteries, in March became the first UCHealth patient treated with balloon pulmonary angioplasty, an emerging procedure for CTEPH patients. Photo courtesy of Connie Starr.\" width=\"640\" height=\"457\" \/><figcaption id=\"caption-attachment-72059\" class=\"wp-caption-text\">Connie and her husband, Jim Starr, at Memorial Park in Woodland Park, Colorado. Connie, who had previously undergone surgery to remove blood clots in major lung arteries, in March became the first UCHealth patient treated with balloon pulmonary angioplasty, an emerging procedure for chronic thromboembolic pulmonary hypertension patients. Photo courtesy of Connie Starr.<\/figcaption><\/figure>\n<p>Lungs have filled countless balloons. Balloons are now returning the favor. They\u2019re doing so through <a id=\"\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7360712\/\" target=\"_blank\" rel=\"noopener\">a procedure<\/a> called balloon pulmonary angioplasty (BPA). It\u2019s a minimally invasive technique through which an interventional cardiologist strings a balloon catheter deep into a lung to open up arteries narrowed by chronic thromboembolic pulmonary hypertension, or <a href=\"https:\/\/phassociation.org\/about-cteph\/\">CTEPH<\/a>.<\/p>\n<p>UCHealth\u2019s <a href=\"https:\/\/www.uchealth.org\/services\/respiratory-lung-care\/comprehensive-lung-breathing-program\/\">Comprehensive Lung and Breathing Program<\/a> performed its first BPA procedure in March, making Connie Starr, 78, of Woodland Park, the first patient of the first BPA program in the region. Starr, who works for a cleaning business, has a family history of blood clots. But she suspects that shoulder-replacement surgery in 2017 triggered hers.<\/p>\n<p>CTEPH happens when blood clots from surgery, trauma, or other causes travel back to the right side of the heart, get pumped to the lungs with blood headed for oxygenation, and get stuck there as pulmonary embolisms. Usually, anticoagulation medications and the body\u2019s own clot-clearing abilities dissolve the clots. But about 4% of the time, the clots gradually get covered like scars by endothelial cells that line arteries. The narrowing or blocking of blood flow stresses the right side of the heart over time.<\/p>\n<p>Shortness of breath, difficulty exercising, fainting, and, with time, heart failure can result.<\/p>\n<h2><strong>First, pulmonary thrombendarterectomy, or PTE<\/strong><\/h2>\n<p>Starr\u2019s CTEPH case was serious. Blood thinners weren\u2019t solving the problem. She was referred to <a href=\"https:\/\/www.uchealth.org\/provider\/todd-bull-md-critical-care-medicine\/\">Dr. Todd Bull<\/a>,\u00a0a University of Colorado School of Medicine pulmonologist and the director of the Comprehensive Lung and Breathing Program at <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-university-of-colorado-hospital-uch\/\">UCHealth University of Colorado Hospital<\/a> (UCH) on the <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-at-university-of-colorado-anschutz-medical-campus\/\">Anschutz Medical Campus<\/a>.<\/p>\n<figure id=\"attachment_19012\" aria-describedby=\"caption-attachment-19012\" style=\"width: 188px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-19012 size-full\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/10\/22092817\/Dr.ToddBull.webp\" alt=\"A photo of Dr. Todd Bull, the doctor who performed a pulmonary thromboendarterectomy, or PTE, on the patient.\" width=\"188\" height=\"246\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/10\/22092817\/Dr.ToddBull.webp 188w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/10\/22092817\/Dr.ToddBull-115x150.webp 115w\" sizes=\"auto, (max-width: 188px) 100vw, 188px\" \/><figcaption id=\"caption-attachment-19012\" class=\"wp-caption-text\">Dr. Todd Bull<\/figcaption><\/figure>\n<p>Scans showed multiple chronic clots, in both the left and right pulmonary arteries \u2013 major arteries in the left and right lung. Bull recommended a major surgery, called a <a href=\"https:\/\/www.uchealth.org\/today\/ten-hour-heart-stopping-surgery-puts-air-force-doctor-back-in-the-race\/\">pulmonary thromboendarterectomy<\/a>, or PTE, to remove them. During the open procedure, the body is chilled to 68 degrees \u2013 about 30 degrees below a normal core temperature. That\u2019s so the patient\u2019s brain and vital organs aren\u2019t damaged when the heart is intentionally stopped for multiple 20-minute sessions during which surgeons remove clots.<\/p>\n<p>In November 2018, UCH became the first hospital in the region to perform a PTE. Five years and 57 successful surgeries later, UCH remains the only institution in the region offering them, with cardiothoracic surgeons <a href=\"https:\/\/www.uchealth.org\/provider\/jordan-hoffman-md\/\">Dr. Jordan Hoffman<\/a> and Dr. Michael Cain performing the operations.<\/p>\n<p>Starr underwent her PTE in January 2022, with cardiothoracic surgeons presiding.<\/p>\n<p>\u201cIt definitely helped,\u201d Starr said.<\/p>\n<h2><strong>Next, balloon pulmonary angioplasty, or BPA<\/strong><\/h2>\n<p>But her symptoms returned, and it became clear that there was more to her CTEPH than those two big clots. Pulmonary embolisms had formed in smaller blood vessels deeper in her lungs. Bull suggested a different approach to opening them up: balloon pulmonary angioplasty. BPA happens not in an operating room but in a catheterization laboratory. The patient remains awake. An interventional cardiologist inserts a balloon catheter into the femoral vein near the groin and then guides it through the right side of the heart and into a lobe of the lung. During a roughly three-hour session, the balloon opens three to five bottlenecks. The patient may do three to five separate BPA sessions in total, Bull says.<\/p>\n<p>\u201cThe goal is to improve pressures, symptoms, oxygenation, and exercise tolerance,\u201d he said. Bull still recommends PTE surgery for patients such as Starr with major clots in surgically accessible lung arteries.<\/p>\n<p>But BPA helping patients who might not withstand PTE surgery as well as patients whose clots are out of reach of PTE surgeons. (One study <a id=\"\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7360712\/\" target=\"_blank\" rel=\"noopener\">estimated<\/a> that more than a third of CTEPH patients fall into these categories.) Then there are patients like Starr, for whom surgery is the first step, but who then may need BPA to reach hard-to-reach residual disease.<\/p>\n<figure id=\"attachment_72061\" aria-describedby=\"caption-attachment-72061\" style=\"width: 250px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-72061\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2023\/10\/05123454\/Kevin-Rogerssized.webp\" alt=\"A photo of Dr. Kevin Rogers, the doctor who performed a balloon pulmonary angioplasty on the patient.\" width=\"250\" height=\"313\" \/><figcaption id=\"caption-attachment-72061\" class=\"wp-caption-text\">Dr. Kevin Rogers<\/figcaption><\/figure>\n<p>Since March, Starr has undergone four BPA procedures. During each session, University of Colorado School of Medicine and UCHealth interventional cardiologist <a href=\"https:\/\/www.uchealth.org\/provider\/kevin-rogers-md-ms\/\">Dr. Kevin Rogers<\/a> has focused on opening arteries in specific, limited areas in the lung, usually staying on one lung segment or lobe during a procedure.<\/p>\n<p>Rogers, whose work typically involves arteries in the heart, kidneys, legs, and elsewhere, described BPA as more \u201ctechnically challenging\u201d than many other catheter-based procedures. Reasons for that include more extreme differences in lung-artery anatomy from patient to patient, a lack of BPA-specific medical devices (he typically uses tools designed for heart procedures), and the need for multiple BPA procedures to achieve desired outcomes. But, he says, it\u2019s worth it.<\/p>\n<p>\u201cThe improvement to patients\u2019 functional status as far as how they feel and perform in everyday life is gratifying,\u201d Rogers said.<\/p>\n<p>Starr is a case in point.<\/p>\n<p>\u201cEach time, I feel better and breathe easier,\u201d Starr said. \u201cI have much more energy than I had before.&#8221;<\/p>\n<h2><strong>Advance the science of BPA<\/strong><\/h2>\n<p>She and Bull are contemplating a fifth BPA procedure. Starr is still on supplemental oxygen \u2013 at 8,600 feet elevation, the air in Woodland Park has about 28% less oxygen than at sea level and 13% less than in Denver.<\/p>\n<p>But Bull hopes that BPA and maintenance medications can help wean her from her cannulas. Bull and colleagues are working to refine the procedure and contribute to the still-limited medical literature on BPA outcomes.<\/p>\n<p>Radiologist <a id=\"\" href=\"https:\/\/www.uchealth.org\/provider\/robert-quaife-md-nuclear-medicine\/\" target=\"_blank\" rel=\"noopener\">Dr. Robert Quaife<\/a> is collaborating with Bull\u2019s team to develop 3D models of lung vasculature that pulmonologists interventional cardiologists can use to prepare for the procedure. Pulmonologist <a href=\"https:\/\/www.uchealth.org\/provider\/yen-rei-yu-md-phd\/\">Dr. Andrea Yu<\/a> is studying the clots removed during PTE surgery to better grasp how they form and what their composition is, the aim being to provide a basis for new treatments.<\/p>\n<p>Starr says she\u2019s doing her part to stay as healthy as she can. She spends an hour at the gym each day, splitting that time between an exercise bike and resistance work. Plus she\u2019s back working and running garage sales on weekends, she says.<\/p>\n<p>\u201cPeople at church say my color is good and ask, \u2018Where do you get all your energy?\u2019\u201d Starr said. \u201cAnd I\u2019m 78 \u2013 I\u2019m not youngster anymore.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Lungs have filled countless balloons. Balloons are now returning the favor. They\u2019re doing so through a procedure called balloon pulmonary angioplasty (BPA). It\u2019s a minimally invasive technique through which an interventional cardiologist strings a balloon catheter deep into a lung to open up arteries narrowed by chronic thromboembolic pulmonary hypertension, or CTEPH. UCHealth\u2019s Comprehensive Lung [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":72059,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[3512],"class_list":["post-72056","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-heart-and-vascular-care-cardiovascular"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Region gets first balloon pulmonary angioplasty program - 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