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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A-E&#41; Optical coherence tomography of A8 segment of the right lower lobe documenting a web lesion &#40;type B&#41;&#59; Pre-BPA&#58; angiogram before balloon pulmonary angioplasty&#59; Post-BPA&#58; angiogram after balloon pulmonary angioplasty&#59; &#40;a-e&#41; optical coherence tomography of A8 segment after dilation with semicompliant balloons &#40;2&#46;0 and 3&#46;0 mm diameter at 58&#46;8 Psi&#41; documenting recanalization of the web lesion&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 73-year-old woman with a history of pulmonary embolism referred to our department due to suspected pulmonary hypertension&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">She was in WHO II functional class and the transthoracic echocardiogram showed pulmonary artery systolic pressure of 58 mmHg&#44; with no right ventricular dilatation or dysfunction&#46; Ventilation&#47;perfusion scan after 3 months of oral anticoagulation confirmed the perfusion defects and right heart catheterization confirmed precapillary pulmonary hypertension &#40;mean pulmonary artery pressure 36 mmHg&#44; pulmonary vascular resistance 5&#46;19 Wood units&#41;&#44; so a diagnosis of chronic thromboembolic pulmonary hypertension was established&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient refused pulmonary thromboendarterectomy and vasodilator therapy was started&#46; In December 2017 the patient was still symptomatic&#44; so she underwent five sessions of balloon pulmonary angioplasty &#40;BPA&#41;&#44; leading to hemodynamic normalization and clinical improvement&#46; In the third session&#44; the A8 segment of the right lower lobe was treated&#46; Slow arterial flow was found&#44; with no venous return&#44; although no lesion was seen on angiography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> Pre-BPA and Video 1&#41;&#46; Optical coherence tomography &#40;OCT&#41; &#40;contrast infusion protocol of 10 ml&#47;s in 4 seconds at 400 psi&#41; documented a web lesion at the level of the bifurcation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A-E&#41;&#46; Dilation with semi-compliant balloons &#40;diameter 2&#46;0-3&#46;0 mm&#41; was performed&#46; OCT after dilation documented lumen expansion and recanalization of the web lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>a-e&#41;&#46; Angiographically&#44; there was improvement in arterial flow and venous return &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> Post-BPA and Video 2&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">OCT is still an experimental tool in BPA that needs further validation&#46; Nevertheless&#44; it is useful in the identification of the type of lesion and for balloon sizing&#44; and can also help to elucidate the pathological mechanisms of the disease&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0295" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Image in Cardiology
Optical coherence tomography-guided balloon pulmonary angioplasty of a web lesion
Angioplastia pulmonar de uma lesão em «favo de mel» guiada por OCT
Sofia Alegria
Corresponding author
asofia.alegria@gmail.com

Corresponding author.
, Rita Calé, Filipa Ferreira, Sílvia Vitorino, Maria José Loureiro, Hélder Pereira
Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2019.05.008
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