Teams at Royal Papworth Hospital in Cambridge carried out the first balloon pulmonary angioplasty (BPA) in 2015 and the hospital was then commissioned by the NHS to provide the service across the UK from 2018.  

The pioneering procedure is now a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are unsuitable for surgery.

Royal Papworth is the only hospital in the country which performs BPA. In summer 2022, the 150th patient was treated using this option. 

What is chronic thromboembolic pulmonary hypertension (CTEPH)?

CTEPH is a relatively rare disease, but it can occur in 2-4% of people following a pulmonary embolism.

It is a form of pulmonary hypertension that occurs as the result of blood clots blocking off the arteries of the lungs. While most of these blood clots originate in the veins, many people with this condition may be unaware that these clots are forming.

Over time, the blood clots build up in the blood vessels of the lungs which become permanently scarred with narrowing and decreased blood flow. This results over time in increased pressure and resistance to blood flow in the lungs leading to pulmonary hypertension and right heart failure. When severe, this situation leads to increasing breathlessness, exercise limitation and reduced life expectancy.

What is balloon pulmonary angioplasty (BPA)? 

The procedure sees an interventional cardiologist insert a very fine wire into blood vessels in the lungs and guide a tiny balloon into position. The balloon is inflated to around the size of a pea for a few seconds to push the blockage aside and restore blood flow to the lung tissue. The balloon is then deflated and removed. This can be repeated several times in different parts of the lung during a single treatment session.

BPA usually involves up to four treatment sessions in the hospital's catheter laboratories, each lasting up to two hours, spaced four to six weeks apart.

The procedure is performed under a light sedation and local anaesthetic; this means that you are given a combination of medicines to help you relax and to block the pain. You may feel very sleepy but will be able to respond to instructions.

Benefits of BPA

Early use of this technique has demonstrated that BPA can significantly improve breathlessness symptoms, lower lung blood vessel pressures and relieve heart failure. The effects appear to be long lasting although further work is required to confirm these results in the longer term.

Case study

After being diagnosed with CTEPH, Elizabeth was told the location of the clots in her lungs were too hard to reach with surgery. However she was given fresh hope when doctors at Royal Papworth Hospital offered her the new BPA treatment as part of the 2016 pilot study.

“It’s been an amazing treatment,” she said. “I was awake through the whole thing – I needed to hold my breath for the clinicians at certain points - but I never felt worried because I had such trust in the medical team.

“It’s a life-changing technique; I can do so much more than I could - I’ve been able to go on holidays and fly around the world to see all my sisters. My quality of life has improved enormously. I’m also able to be a lot more active with my toddler granddaughter. She was due to be born just as I fell ill.

“It’s wonderful news that NHS England is commissioning BPA at Royal Papworth Hospital so more people can get their lives back.”

I have felt very safe. The staff are fantastic and very caring.
Patient, had BPA in 2020

Awards and milestones 

In spring 2020 the hospital’s pulmonary vascular disease unit was shortlisted for the prestigious Royal College of Physicians Excellence in Innovation Award for ‘pioneering BPA for patients with inoperable chronic thromboembolic disease’.

In October 2020, a team led by Dr Steve Hoole treated the 100th BPA patient at Royal Papworth Hospital. 

Further information

If you have queries, please contact our pulmonary hypertension specialist nurses on 01223 638826 or via the Royal Papworth Hospital switchboard on 01223 638000 and ask for bleep 343.

A pulmonary hypertension consultant is available via the switchboard for medical advice if the pulmonary hypertension specialist nurse is unable to answer your query.

Patient guides

Balloon pulmonary angioplasty (BPA)
Chronic Thromboembolic Pulmonary Hypertension (CTEPH)