Pulmonary Artery Denervation for Idiopathic Pulmonary Arterial Hypertension: A Case Report

Pulmonary arterial hypertension (PAH) is a life-threatening condition characterized by significantly elevated pulmonary artery pressure (PAP) and resistance. While targeted drugs can alleviate symptoms, their long-term efficacy is limited, and treatment is often associated with notable side effects and financial burden. Percutaneous pulmonary artery denervation (PADN) offers a novel interventional approach for PAH patients with inadequate responses to targeted therapy by selectively ablating sympathetic nerves and restoring neurohumoural balance. This case report describes a 67-year-old male with severe PAH who underwent PADN after showing a poor response to long-term macitentan and tadalafil therapy. Immediate postprocedure haemodynamics revealed a reduction in mean PAP (mPAP) from 42 mmHg to 32 mmHg and a 16% decline in pulmonary vascular resistance (PVR; 10.10 to 8.48 Wood units). A 6-month follow-up demonstrated sustained improvements in the 6-min walk distance (6MWT), WHO functional class, Borg dyspnoea index, and NT-proBNP levels. Clinical studies have confirmed that PADN can significantly improve the haemodynamics and exercise tolerance of medium- to high-risk PAH patients by inhibiting excessive sympathetic nervous system activity and promoting pulmonary vasodilation, especially when combined with targeted drugs, which can produce synergistic effects. However, large-index trials are needed to validate its long-term efficacy, expanded indications, and procedural standardization.