Pulnovo Medical Limited, a globally recognized OTM innovative platform, recently announced that on May 12, 2022, the "Pulmonary Hypertension Masterclass 2022" webinar was successfully held, co-organized by the National Center of Pulmonary Vascular Disease, China (NCPVD), Society for Catheterization and Interventions (SCAI) and Left Main & Coronary Bifurcation Summit (CBS), with the assistance of Pulnovo Medical. A dozen globally renowned experts gathered online to share the updated diagnosis and treatment progress of Pulmonary Hypertension(PH) all over the world, creating a high-quality audio-visual academic feast.

This conference was co-chaired by Prof. Shaoliang Chen (Nanjing First Hospital Affiliated to Nanjing Medical University), Prof. Ehtisham Mahmud (San Diego Health Center), Prof. Raymond L. Benza (Ohio State University Wexner Medical Center) and Prof. Hong Gu (Beijing Anzhen Hospital, Capital Medical University), and a whole host of esteemed panelists from China's top medical institutions. During the webinar, Chinese and American experts had a enthusiastic discussion on the most prevalent issues in the field of PH, including the present situation and future direction.

Pulmonary Hypertension (PH) is termed as the cancer of the cardiovascular system. In recent years, due to the development of interventional therapy technology and medical equipment, the diagnosis and treatment of PH has made great progress. Under such circumstances, how to achieve accurate diagnosis and provide appropriate treatment for the vast number of patients with PH has become a hot topic in this field.

The Masterclass covered numerous topics with panelists sharing their perspectives, the highlights of which included the following:

Prof. Shao-Liang Chen: PADN for Pulmonary Arterial Hypertension

Professor Shaoliang Chen introduced the background of percutaneous pulmonary denervation (PADN) which is an interventional therapy for PH independently developed in China. Professor Chen introduced that pulmonary arterial pressure is regulated by multiple organs in the body, among which the imbalance of neurohormonal regulation is an important cause, which is also closely related to the poor prognosis of patients. Studies demonstrate that norepinephrine plays an important role in the occurrence and development of PH. In animal models, researchers notice that sympathetic anatomic remodeling occurs around the diseased pulmonary vessels. And pulmonary denervation achieves good therapeutic effects in both acute and chronic PH animal experiments.

PADN-CFDA is a multicenter, randomized, blind, sham-operated controlled clinical trial, involving 65 patients in the sham-operated group and 63 patients in the surgical group, and the endpoint was 6-minute walking distance at the 6th month after surgery. This study further demonstrates the efficacy and safety of PADN. Besides, patients with CHD were also included in this trial, and the results provide more information on how to treat these patients.

Prof. Raymond L. Benza: Contemporary Risk Stratification in Adult PAH

Professor Benza gave a detailed presentation on risk stratification in adult patients with PH, and introduced commonly used methods to assess prognosis and guide treatment based on risk stratification, pointing out that the average expected survival time of patients with PH is only 7 years and in order to improve the prognosis and prolong the lifespan of patients, it is also very important to optimize the integrated management of patients in addition to the development of new therapies.

Currently, the risk stratification tool used in the European guidelines classifies patients into three lines of risk: low risk (<5%), medium="" risk="" and="" high="">10%), based on symptoms and examination results. REVEAL 2.0, a risk calculation form commonly used in the United States, also provides significance differentiation in patient risk stratification. The assessment items in this risk calculation form are comprehensive and practical, which can effectively help doctors identified  high-risk patients. Professor Benza emphasized that in clinical practice, attention should be paid to distinguishing between different risk assessment tools, and choosing the most appropriate one.

Prof. Ehtisham Mahmud: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and the Role of PTE Surgery and Balloon Pulmonary Angioplasty

Professor Mahmud presented the current application of surgical operation in patients with CTEPH, including pulmonary thromboembolic endarterectomy (PTE) and percutaneous pulmonary balloon angioplasty (BPA), reminding everyone, when considering diagnosis, that the absence of venous thrombosis history could not rule out CTEPH. Common misdiagnoses that are easily confused with CTEPH include COPD, asthma and diastolic CHF. Patients with dyspnea should be considered for a diagnosis of PH, and the possibility of CTEPH in all patients with PH should be considered. Pulmonary angiography is one effective diagnosis means for CTEPH.

Professor Mahmud pointed out for BPA operations the femoral vein is usually chosen as the surgical route. The most commonly used surgical instruments included 8-9F intravenous sheath, 6F guide catheter, 0.014 polymer-free guide wire and 2-5mm balloon. In operations, heparin was needed for anticoagulation and the ACT score should be maintained between 200 and 250 seconds. However, IVUS and OCT are rarely needed, and resting pressure differential order (Pd/Pa) is often used to guide and optimize surgical outcomes instead.

The choice of appropriate therapy, including surgery, interventional operation and medication, were evaluated by a CTEPH team from different disciplines, Professor Mahmud said. Currently, surgery is still the most effective and appropriate treatment for patients with CTEPH.

Prof. Hong Gu: Treatment of CHD with PAH

Professor Hong Gu described the latest progress of congenital heart disease (CHD), one of the common causes of PH, from the perspectives of current status, remaining challenges and future development. CHD is the most common birth defect in newborns. With the improvement of medical equipment in primary medical institutions, the detection rate of CHD continued increasing, and the number of patients receiving interventional treatment also grew steadily. According to statistics data, about 150,000 newborns with CHD were born in 2018.

PH associated with CHD included Eisenmenger syndrome, body-lung shunt associated PAH, PAH with small defects and postoperative PAH. In terms of geographical distribution characteristics, PH associated with CHD is more common in Asian and African countries. PAH-CHD is the most common cause of PAH in China, among which Eisenmenger syndrome and postoperative PAH are the most common subtypes. It is unfortunate, as Professor Gu pointed out, there is still no unified standard for surgical indications, which can be seen from existing guidelines and clinical studies. A clinical study conducted by Professor Gu's team found that inhalation of Iloprost can improve hemodynamic parameters in children with PAH-CHD.