First pulmonary artery balloon angioplasty performed in Croatia

(Photo: KBC Split)

The first balloon pulmonary angioplasty (BPA) procedures for patients with chronic thromboembolic pulmonary hypertension (CTEPH) in Croatia have been successfully carried out at the Clinical Hospital Centre (KBC) Split.

Until now, Croatian patients requiring this minimally invasive treatment were referred to a specialist clinic in Austria via the Ministry of Health’s Reference Centre for Pulmonary Circulation Diseases at KBC Zagreb.

Thanks to the Split cardiology team, this is no longer necessary.

The milestone was achieved by an interventional cardiology team led by Dr Mislav Lozo, with Dr Dino Mirić, nurses Kristina Ruščić, Mirjana Lativnović, Katarina Gavranić, and radiology engineers Josip Ujević and Matea Bolčić, KBC Split said in a statement.

The procedures were carried out under the guidance of Professor Slobodan Obradović, an experienced interventional cardiologist from the Military Medical Academy in Belgrade, who has performed around 200 such interventions.

Both patients reported a significant improvement just hours after the procedure, saying they could “finally breathe again”.

Understanding CTEPH

CTEPH is a rare form of pulmonary hypertension caused by chronic blood clots in the pulmonary arteries. It develops in 1–2% of cases following a pulmonary embolism, even with anticoagulant therapy.

Residual clots hinder blood flow, cause chronic inflammation, and lead to scarring, narrowing the vessels and increasing pressure in the pulmonary circulation.

(Photo: KBC Split)

Symptoms include breathlessness, reduced exercise tolerance, leg swelling, jugular vein distension, liver and spleen enlargement, fainting spells, and coughing up blood.

Diagnosis can be challenging. It begins with an echocardiogram to assess right heart size and function, followed by right heart catheterisation, and, if indicated, lung ventilation-perfusion scintigraphy and CT pulmonary angiography.

Treatment Options

The main treatment is pulmonary endarterectomy – a complex surgery performed in highly specialised centres abroad.

However, at least 40% of patients are not candidates due to technical inoperability, other medical conditions, or limited access to surgery. In recent years, the medication riociguat has also been approved for CTEPH treatment.

Balloon pulmonary angioplasty, a less invasive alternative for non-surgical candidates, involves opening narrowed or blocked pulmonary arteries using a catheter and balloon, improving blood flow and reducing pulmonary pressure.

A Step Forward for Croatian Cardiology

Professor Darija Baković Kramarić, Head of the Department of Cardiology at KBC Split, said the introduction of BPA in Split “proves once again the consistency and determination of our cardiology team in keeping pace with global trends in cardiovascular treatment”.

She credited the achievement to “continuous training, perseverance, enthusiasm, dedication to the profession, and the clinic’s well-organised workflow”.

Dr Lozo expressed gratitude to Dr Frane Runjić, Head of the Department for Ischaemic Heart Disease, and Professor Baković Kramarić for their support in bringing the procedure to Split.

With this breakthrough, Croatia joins the growing number of countries offering this life-changing procedure domestically – allowing CTEPH patients to breathe easier without leaving home.