Calé, RitaCaldeira, Daniel2023-02-102023-02-102023Rev Port Cardiol. 2023 Feb;42(2):145-1470870-2551http://hdl.handle.net/10451/56246© 2023 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease which, although rare, is associated with significant morbidity and mortality when left untreated. It is characterized by the obstruction of the pulmonary arterial vasculature by organized thrombotic material, with consequent fibrotic reaction, intimal thickening, vascular remodeling, and plexiform lesions, leading to increased resistance and pressure in pulmonary circulation, right heart overload, right ventricular failure, and death.1 Pulmonary arterial endarterectomy (PEA) surgery is the first-line therapy which, when performed in experienced centers, has hospital mortality of less than 5% and provides hemodynamic and functional improvement with good long-term survival.2 Balloon pulmonary angioplasty (BPA) is an alternative approach in inoperable or residual/recurrent CTEPH patients after PEA, with favorable results in terms of functional clinical improvement, exercise capacity, haemodynamics and survival.engjournal article10.1016/j.repc.2022.12.0052174-2030