A long way to go after the initial experience with balloon pulmonary angioplasty.

To date, the standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH) has been surgical pulmonary endarterectomy (PEA) followed by life-time anticoagulation therapy [1]. However, excellent results with PEA have been limited to select centres with experience and expertise; many patients who are possible candidates for PEA at expert centres would be considered ineligible in many countries [2]. Medical treatment has shown little or no improvement in haemodynamic parameters in patients with CTEPH who are ineligible for PEA [3, 4]. Thus, despite partial success of balloon pulmonary angioplasty (BPA) in the USA [5], attempts to treat patients with CTEPH by BPA have increased in several countries where PEA is not widely performed [6–8]. Before starting a BPA programme, two main problems in the initial report [5] need to be resolved: its low efficacy and high incidence of complication.