My 2nd BPABalloon Pulmonary Angioplasty Balloon pulmonary angioplasty, or BPA for short, is a technique for widening narrowed or blocked blood vessels in the lungs of CTEPH patients. Small balloons attached to a catheter restore blood flow to areas of the lungs that do not receive blood due to the disease.  When successful, BPA eliminates or reduces shortness of breath, increases exercise tolerance and quality of life, and extends life expectancy. procedure is behind me. Everything went well and without complications. My medical team is fabulous. They are a pleasure to work with. It all happens in a relaxed atmosphere. Entering the catheter room (a special operating room) feels like stepping into a coffee shop to meet friends.

The patients head on the stretcher during BPA treatment; in the background machinery and monitors.
That’s me during my BPA procedure. Nothing to do. When I spotted the photographer, I signaled with my eyes, “Picture, please.”

BPA is a fascinatingly simple procedure. My biggest challenge is not falling asleep. Fortunately, Dr. Matsubara taps me on the leg whenever he needs my participation to hold my breath. – Wake up! Action!

Holding my breath for a few seconds now and then is my only contribution to the treatment. When I take a deep breath and hold it, my pulmonary artery straightens up, making it easier for the doctors to see the characteristics of a lesion.

Shifting the catheter to a different pulmonary artery segment can take more than 10 minutes and requires considerable expertise and fingerspitzengefühlFingerspitzengefühl Fingerspitzengefühl is a German term, literally translated as "fingertips feeling". It means having an innate instinct about any given scenario and knowing how to react to it without having to think about it. It also implies a particular touch or sensitivity that comes with experience. The term has been adopted by the English language as a loanword. - Sources: wikipedia.org and Transparent Language.

The first session focused on the right side of my lungs; today, the target was the left lobe. Right, left, …Targeting different sides of the lungs per treatment is part of the success of the Okayama Method (also known as the Matsubara Method; see references below).

A typical BPA session lasts 90 minutes, with roughly one hour for the core treatment (the actual catheter time), about 15 minutes for preparation, and another 15 minutes for cleanup and observation.

At around 13:00 (1 pm), the nurse fetched me from my room and wheelchaired me to the catheter room on the 5th floor of the OMC. The team was preparing for my treatment and began to grin when they noticed me. Friendly people, indeed!

Action in the catheter room. – From left to right, Dr. Hiromi Matsubara, Dr. Hirofumi Okada, and Dr. Michiko Ueki. I’m the guy hiding under all the plastic wrappers. The monitors show my vital signs and images of my pulmonary arteries.

Lots of high-tech equipment in the catheter room makes it appear more like a repair shop than an operating theater, a lung tuneup shop. Basically, that’s what is going on there. They are tuning me up, expanding my oxygen capacity.

More about the catheter room (including photos) in this post.

This time they inserted the catheter through a cut on the left side of my groin, the left femoral vein. As usual, a tiny prick of local anesthesia, and in went the catheter. From there on, I didn’t feel much more than some occasional mild pushing and shoving.

Inferior vena cava, kidneys, and iliac veins in a drawing also showing part of the ribcage, spine and the illiacum.
Inferior Vena Cava – AnatomyZone

Regardless of the insertion point, the catheter must travel through my veins and through the right side of my heart into my lungs.

Every time they moved the catheter, I felt a mild sensation in my abdomen (see pressure points). Nothing to worry about, but interesting.

When the catheters are all removed at the end of the treatment, it’s time for the snapshot, the routine chest x-ray. For this purpose, they bring in a portable X-ray machine. No grin is required, but I must hold my breath one last time.

Once the session was over, two nurses from ward 9B came to get me with my bed. I had to lay flat for two hours to avoid stressing the cut in my groin. Excessive bleeding of the wound is possible because I am on blood thinners (anticoagulants). Keeping my leg totally still is the best way to ensure proper wound closure.

The nurses kept me outside the catheter room door for a few more minutes before pushing me to the elevator. Like last time, doctors and the entire team gathered around my bed, we began joking and laughing and finished with a big smile.

Unlike last time, they put me on supplemental oxygen after the procedure. It was merely a precaution. First, at a flow rate of 5 L/min. After about 30 minutes, the nurse reduced it to 3 L/min, which stayed at that all night. An oxygen cylinder was waiting next to my bed to go pee with me. Reason: my blood oxygen saturationBlood Oxygen Saturation (SpO2) The oxygen saturation (SpO2) of a person's blood is defined as a percentage of the maximum amount (100%) of oxygen it can transport. A healthy person's SpO2 percentage should be between 96% and 99%. - Source: What is oxygen saturation (SpO2)? What is the normal range for SpO2??. Retrieved 11 November 2022, from ihealthlabs.com (SpO2Blood Oxygen Saturation (SpO2) The oxygen saturation (SpO2) of a person's blood is defined as a percentage of the maximum amount (100%) of oxygen it can transport. A healthy person's SpO2 percentage should be between 96% and 99%. - Source: What is oxygen saturation (SpO2)? What is the normal range for SpO2??. Retrieved 11 November 2022, from ihealthlabs.com) was relatively low at the end of the treatment. The following day, SpO2 was normal again.

I feel honored and very grateful to Dr. Matsubara. Despite his busy schedule, he performs all BPA procedures himself. Dr. Hiromi Matsubara MD, PhD, is the Deputy Director of the National Hospital Organization Okayama Medical Center (OMC) and head of the hospital’s PHPulmonary Hypertension (PH) High pressure in the blood vessels leading from the heart to the lungs is called pulmonary hypertension. The arteries in the lungs and the right side of the heart are affected by pulmonary hypertension. If untreated, the right side of the heart will weaken over time, eventually leading to heart failure and death. The WHO has defined five distinct groups of pulmonary hypertension, each with a different cause. CTEPH is a form of PH (WHO group 4). - References: mayoclinic.org and cdc.gov team (including CTEPHChronic Thromboembolic Pulmonary Hypertension CTEPH is short for chronic thromboembolic pulmonary hypertension, a rare form of high blood pressure in the lungs caused by blood clots or narrowed blood vessels. High blood pressure in the lungs is often also called pulmonary hypertension.). His expertise and skills, sharpened over a decade and a half, are crucial to the success of my treatment.

End of my report. BPA is easy and virtually painless.

Looking forward to my 3rd BPA session.

References

The Okayama Method of BPA is outlined in a 2018 paper by Ogawa & Matsubara [1]. Chapter 5 of the Springer 2022 eBook [2] provides an overview of the modern BPA technique performed at Okayama Medical Center. The authors are again Ogawa & Matsubara.

[1] Ogawa, A., & Matsubara, H. (2018). After the Dawn – Balloon Pulmonary AngioplastyBalloon Pulmonary Angioplasty Balloon pulmonary angioplasty, or BPA for short, is a technique for widening narrowed or blocked blood vessels in the lungs of CTEPH patients. Small balloons attached to a catheter restore blood flow to areas of the lungs that do not receive blood due to the disease.  When successful, BPA eliminates or reduces shortness of breath, increases exercise tolerance and quality of life, and extends life expectancy. for Patients With Chronic Thromboembolic Pulmonary HypertensionChronic Thromboembolic Pulmonary Hypertension CTEPH is short for chronic thromboembolic pulmonary hypertension, a rare form of high blood pressure in the lungs caused by blood clots or narrowed blood vessels. High blood pressure in the lungs is often also called pulmonary hypertension.. Circulation journal : official journal of the Japanese Circulation Society, 82(5), 1222–1230. https://doi.org/10.1253/circj.CJ-18-0258

[2] Matsubara, H., Ogawa, A. (2022). Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: Modern Technique. In Saia, F., Galiè, N., Matsubara, H. (Eds.). Balloon pulmonary angioplasty in patients with CTEPH (chapter 5). Springer. https://doi.org/10.1007/978-3-030-95997-5

Note: The video and the photos in this post were taken by the OMC with my permission during this BPA session. Thanks to Dr. Matsubara for the photo opportunity and for allowing me to publish these images.