3 The procedure
3.1 Balloon pulmonary angioplasty (BPA) aims to reduce pulmonary hypertension by dilating stenoses in the main or subsegmental pulmonary arteries. The procedure is usually done using a local anaesthetic, with the patient fully anticoagulated. A standard right heart catheterisation is done through the internal jugular vein or femoral vein. The stenosed and occluded arteries that need treatment are identified using selective pulmonary angiography. A balloon catheter is advanced through the stenosis or occlusion, over a guide wire. The balloon is then inflated to dilate each target artery. Between 1 and 6 segmental or subsegmental arteries may be treated during each BPA procedure. The procedure may be repeated until desired haemodynamic measurements are attained.