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What is Balloon Pulmonary Angioplasty? (BPA)

BPA is an interventional radiology procedure done by an Interventional Radiologist, in which a catheter is inserted into your blood vessels and a balloon is inflated to open up the vessel and increase blood flow throughout your lungs.

Currently, the only treatment center for BPA in Canada is at the Toronto CTEPH Program. (?link)

The CTEPH team will decide if BPA is right for you based on the following:
  • You are not a candidate for PEA surgery.
  • The clots or scar tissue blocking the blood vessels in your lungs are deep in the outer areas of your lungs and cannot be removed by PEA surgery.
  • You had PEA surgery and continue to have pulmonary hypertension or ongoing shortness of breath.

Outcomes of BPA

  • Prevent the right side of your heart from getting weaker and decreasing your pulmonary hypertension pressure if it is elevated.
  • Improve the blood flow in your lungs to help improve your shortness of breath.

What to expect if referred to the CTEPH program

An initial consultation with the CTEPH thoracic surgeon to review whether PEA or BPA is appropriate (this is done virtually if you live outside of Ontario).

Your referring physician will be required to send copies of your lung CT scans for the CTEPH team and Interventional Radiologist to review.

Once the CTEPH team has decided you are a BPA candidate, you will:
  • Undergo a pulmonary angiogram (in your province or at the Toronto General Hospital if you live in Ontario). This is a similar test to a CT scan where a radiologist injects contrast dye to find which blood vessels are blocked. This will help determine how many BPA sessions you will need.
  • Have an initial phone or video consultation with the Interventional Radiologist once the CT scans and pulmonary angiogram is reviewed to talk about how BPA is done and to describe the risks and benefits of the procedure.
  • If you have pulmonary hypertension, you may be started on pulmonary hypertension medication, called Riociguat, for at least 3 months before any BPA procedure. This is because recent research has shown Riociguat in combination with BPA results in fewer serious adverse events in hospital and can further help decrease the high blood pressure in your lungs.
  • Once the interventional radiologist has determined how many BPA sessions you will need (typically 2 to 8 BPA sessions), you will receive a call with your date(s) one to two months before the BPA sessions.
  • The CTEPH nurse coordinator will then call you to discuss a detailed care schedule and instructions for when you are admitted to hospital. If you live outside of Ontario, the CTEPH nurse coordinator and your referring physician will help coordinate your flight to Toronto and accommodation details during your stay. We recommend  that you do not pre-book your flight home in case of changes throughout your hospital stay. The CTEPH team will help you book your return flight home was you have an anticipated discharge day.
  • If you live outside of Ontario and require more than 2 BPA sessions, the CTEPH team will try to coordinate your sessions in consecutive weeks so that you do not need to travel multiple times to Toronto. This may require you to stay in accommodations outside of the hospital between sessions (typically on the Saturday and Sunday between each week).

What to expect during your hospital stay

You will get a detailed care schedule with printed instructions from your CTEPH coordinator several days before your admission at the Toronto General Hospital.

The average length of stay in hospital for your BPA procedure is 4 days. During your hospital stay, 2 BPA sessions will be done. You will be monitored on the ward for 1 day between each session. Mentioned above, if you will be having more than 2 sessions consecutively, you will be discharged from hospital on day 4 and return the next week for your next 2 sessions. Typically this occurs over the weekend.

You will be required to do bloodwork within 30 days of your first BPA procedure.

It is important to note that you will remain on your blood thinner for the procedure. The interventional radiologist does BPA on full anticoagulation.

For full details on your hospital stay, refer to pages 6 to 11 in this patient information guide.

The CTEPH team will help you plan your flight home once you have an anticipated discharge day.

After discharge, you can expect a follow up phone consultation with the interventional radiologist around 3-6 weeks after your BPA procedures.

You will also be schedule for follow up appointments at the Toronto CTEPH program with the thoracic surgeon or with your referring doctor in your province.
  • Follow up includes an echocardiogram, 6-minute walk test and blood work at 6 months.