A 67-year old woman presented with chronic thrombo- embolic pulmonary hypertension (CTEPH). Patient also presented with shortness of breath, obstructive sleep apnea and hypertension. The Ventilation Perfusion Scan demonstrated multiple mismatched bilateral perfusion defects & CT Chest Angiogram had no evidence of acute pulmonary embolism (PE); however evidence of mosaicism and diminutive segmental and sub-segmental arteries are noted bilaterally. No evidence of Coronary Artery Disease (CAD). She was considered a non-surgical candidate given distal disease on pulmonary angiography & was referred for Balloon Pulmonary Angioplasty and underwent 5 Balloon Pulmonary Angioplasty sessions.