Long-Term Supervised Cardiac Rehabilitation After Balloon Pulmonary Angioplasty Improved Residual Exercise Pulmonary Hypertension in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Two-Case Report.

Abnormal pulmonary hemodynamics during exercise may persist even after balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). We report two female patients who underwent long-term supervised outpatient cardiac rehabilitation (CR) after BPA with continuous pulmonary vasodilators. In Case 1, training was performed at an intensity close to the anaerobic threshold. In Case 2, high-intensity interval training (HIIT) was gradually introduced. Exercise right heart catheterization was used for serial assessment of the mean pulmonary arterial pressure/cardiac output slope (mPAP/CO slope). Functional outcomes were also evaluated by cardiopulmonary exercise testing. No adverse events occurred during follow-up. The mPAP/CO slope improved from 6.28 to 4.06 mmHg/L/min at 12 months in Case 1 and from 8.40 to 6.71 mmHg/L/min at 18 months in Case 2. Peak VO2 also increased from 16.2 to 20.2 mL/kg/min in Case 1 and from 18.3 to 24.9 mL/kg/min in Case 2. Long-term supervised outpatient CR after BPA appears to be feasible and may improve exercise pulmonary hemodynamics and exercise capacity.