PMC8348489_01
The computed tomography (CT) pulmonary angiography showed a small fresh thrombus in the right A10 (yellow arrow) and chronic thromboembolic obstruction of the bilateral distal pulmonary artery. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Computed tomography (CT) pulmonary angiography showed a small fresh thrombus in the right A10 and chronic thromboembolic obstruction of the bilateral distal pulmonary artery (Fig. 1).
The comparison of pulmonary angiography. (a): pulmonary angiography of right pulmonary artery before BPA; (b): pulmonary angiography of right pulmonary artery after BPA.; (c): pulmonary angiography of left pulmonary artery before BPA; (d): pulmonary angiography of left pulmonary artery after BPA. We increased the pulmonary flow slightly not to cause high perfusion injury or balloon injury.
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We performed BPA in the right (A1, A3, A5, A7, A8, A10) and left (A5, A8, A9, A10) pulmonary arteries with a small balloon with a diameter of 2.0 and 3.0 mm (Fig. 2).
PMC8348489_02
The enhanced CT showed a small defect of fresh thrombus (yellow arrows) in the bilateral pulmonary arteries at the segmental or subsegmental levels and signs of CTEPH. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Enhanced CT showed a small defect of fresh thrombus in the bilateral pulmonary arteries at the segmental or subsegmental levels and signs of CTEPH including intimal thickening and abrupt narrowing and occlusion in the bilateral pulmonary artery (Fig. 3).
Pulmonary angiography before BPA revealed only a small fresh bloody thrombus in the right A1 and left A9 and chronic thromboembolic lesions of webs, subtotal occlusion, and total occlusion in the bilateral pulmonary arteries at segmental levels.
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Pulmonary angiography revealed only a small fresh bloody thrombus in the right A1 and left A9 and chronic thromboembolic lesions of webs, subtotal occlusion, and total occlusion in the bilateral pulmonary arteries at segmental levels (Fig. 4).
The comparison of pulmonary angiography. (a): pulmonary angiography of left pulmonary artery before BPA; (b): pulmonary angiography of left pulmonary artery during BPA.; (c): pulmonary angiography of left pulmonary artery after BPA. We traversed the lesion with the guide wire shallowly to prevent wire injury. We approached the lesion with an undersized balloon to prevent high perfusion injury or balloon injury and increased the pulmonary flow in each segment slightly.
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We performed BPA in the right (A3, A5, A9, A10) and left (A8, A9, A10) pulmonary arteries (Fig. 5).