The current treatment algorithm for chronic thromboembolic pulmonary hypertension (CTEPH) as depicted in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnosis and treatment of pulmonary hypertension (PH) includes a multimodal approach of combinations of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapies to target major vessel pulmonary vascular lesions, and microvasculopathy. Today, BPA of >1700 patients has been reported in the literature from centers in Asia, the US, and also Europe; many more patients have been treated outside literature reports. As BPA becomes part of routine care of patients with CTEPH, benchmarks for safe and effective care delivery become increasingly important. In light of this development, the ESC Working Group on Pulmonary Circulation and Right Ventricular Function has decided to publish a document that helps standardize BPA to meet the need of uniformity in patient selection, procedural planning, technical approach, materials and devices, treatment goals, complications including their management, and patient follow-up, thus complementing the guidelines. Delphi methodology was utilized for statements that were not evidence based. First, an anatomical nomenclature and a description of vascular lesions are provided. Second, treatment goals and definitions of complete BPA are outlined. Third, definitions of complications are presented which may be the basis for a standardized reporting in studies involving BPA. The document is intended to serve as a companion to the official ESC/ERS guidelines.

Aarhus University Hospital Palle Juul Jensens Boulevard 99 8200 Aarhus NDenmark

Cardiology Department Grenoble Alpes University Hospital 38043 Grenoble France

Department of Cardiology Bern University Hospital Inselspital University of Bern Freiburgstrasse 18 3010 Bern Switzerland

Department of Cardiology National Hospital Organization Okayama Medical Center 1711 1 Tamasu Kita ku Okayama 701 1192 Japan

Department of Cardiology Oslo University Hospital Rikshospitalet Pb 4950 Nydalen 0424 Oslo Norway

Department of Cardiology St Antonius Hospital Koekoekslaan 1 3435 CM Nieuwegein The Netherlands

Department of Cardiology University Medical Center Utrecht Heidelberglaan 100 3584 CX Utrecht The Netherlands

Department of Internal Medicine 2 Cardiology and Comprehensive Center of Cardiovascular Medicine CCVM Medical University of Vienna Währinger Gürtel 18 20 Vienna A 1090 Austria

Department of Internal Medicine and Cardiology Medical University of Warsaw Zwirki 1 Wigury 61 02 091 Warsaw Poland

Department of Pulmonary Circulation Thromboembolic Diseases and Cardiology Centre of Postgraduate Medical Education EHC Otwock Borowa 14 18 Otwock 05 400 Poland

Department of Thoracic Surgery Kerckhoff Heart and Thorax Centre Benekestrasse 2 8 61231 Bad Nauheim Germany

Dept of Cardiology and Cologne Cardiovascular Research Center Heart Center at the University Hospital Cologne Kerpener Str 62 50937 Köln Germany

Dipartimento DIMEC Università di Bologna 40126 Bologna Italy

General University Hospital U Nemocnice 2 128 08 Prague 2 Czech Republic

Hospital Universitario 12 de octubre Avda de Cordoba SN 28041 Madrid Spain

Interventional Radiology Department Marie Lannelongue Hospital Le Plessis Robinson 92350France

Medizinische Hochschule Hannover Institut für Diagnostische und Interventionelle Radiologie Carl Neuberg Str 1 30625 Hannover

Pulmonary Circulation Centre Jagiellonian University Medical College John Paul 2 Hospital in Krakow Pradnicka Str 80 31 202 Krakow

Royal Free Hospital London Pond Street Middlesex London NW3 2QG

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