This study aimed to evaluate the hemodynamic alterations and right heart remodeling dynamics in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) undergoing treatment with balloon pulmonary angioplasty (BPA).This retrospective cohort study involved a cohort of 31 patients with a confirmed diagnosis of CTEPH. Comprehensive clinical evaluations were systematically performed before BPA, and at 3 and 6 months following the procedure.Significant clinical progress was evidenced by the uplift in the percentage of patients achieving WHO-FC II, escalating from 19.35% at baseline to 51.61% at 6 months after BPA (p = 0.003). NT-proBNP levels significantly dropped from a median of 614.6 to 69.9 pg/mL (p < 0.001). Hemodynamic assessments showed significant decreases in mean PAP from 45.53 ± 11.19 to 22.56 ± 5.81 mmHg (p < 0.001) and PVR from 8.33 to 2.86 WU (p < 0.001). Echocardiographic analysis revealed substantial reductions in the right atrial area (RAA, from 20.29 ± 7.55 to 16.79 ± 4.82 cm2, p < 0.001) and right ventricular internal diameter (RVID, from 4.13 ± 0.79 to 3.68 ± 0.59 cm, p = 0.001) at the 3-month interval post-BPA. These improvements were sustained or even enhanced by the 6-month mark, with RAA and RVID further diminishing (to 14.46 ± 3.78 cm2 and 3.29 ± 0.54 cm, respectively; both p < 0.01). The TAPSE/PASP ratios showed progressive improvement from baseline (0.32 ± 0.13) to 3 months (0.42 ± 0.13) and continued to improve at 6 months following BPA (0.50 ± 0.11, p = 0.04 compared to 3 months post-BPA).BPA has significantly ameliorated clinical conditions, hemodynamic profiles, and initiated a continued reversal in right heart remodeling in patients with CTEPH.© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.