Duke Health Referring Physicians

Quick Case Study

Uncommon Fatigue, Dyspnea Frighten Older Patient

CTEPH diagnosis presents treatment challenges

Illustration of heart

A physically active 82-year-old woman began to experience dyspnea and fatigue during routine daily activities that was unfamiliar and disturbing. The rapid decline in respiratory function frightened her. With the help of family members, she sought care from a specialist.

The diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) presented therapeutic challenges because of her age. Cardiologists at her regional hospital who diagnosed CTEPH determined that the risk was too great for the patient to undergo pulmonary thromboendarterectomy (PTE), the complex surgery required to treat CTEPH. When the woman began exploring other options, her research brought her to Duke’s Center for Pulmonary Vascular Disease.

Question: What approach did Duke specialists recommend to the patient?

Answer: The Duke CTEPH team recommended balloon pulmonary angioplasty (BPA), a nonsurgical vascular remodeling option that typically requires multiple catheter-based procedures.

An innovative and relatively rare therapy, the catheter-based treatment offers a nonsurgical option to treat CTEPH, says Richard A. Krasuski, MD, the cardiovascular interventionist who performs BPA for the Duke Pulmonary Vascular Disease Program. BPA opens vessels and improves blood flow that then heals diseased tissue and encourages vascular remodeling, Krasuski says.

“She was certainly one of the older patients we’ve performed this procedure on, but she was feeling pretty miserable,” Krasuski says. “She was not a candidate for PTE, so we thought this approach would offer an effective solution.”

Over seven months, the patient underwent four vascular remodeling procedures. Most patients require at least three procedures, Krasuski says. Now six months after her final procedure, the patient no longer suffers dyspnea or fatigue, and her respiratory function is normal for her age. The patient continues to improve on a six-minute walk test used to assess patients following cardiac procedures.

An innovative center for CTEPH treatment

The Duke Center for Pulmonary Vascular Disease is one of the leading centers for CTEPH treatment in the nation and one of only a few offering the less invasive BPA option. In addition to PTE and BPA, the center offers medical therapies using riociguat, a soluble guanylate cyclase stimulator.

After introducing the procedure at Duke in 2018, Krasuski has performed more than 100 BPA cases, and the number of patients seeking the therapy is trending upward. He estimates that the team now performs approximately 50 BPA procedures annually.