The BMPR2 c. 247+2del variant is in the canonical donor site of intron 2, leading to in frame exon skipping. The variant is absent from gnomAD v4.1.0 and v2.1.1 (controls) (PM2_supporting). This variant has been reported in one heritable PAH proband (PMID:26387786) (PS4 not met). The in frame deletion removes 5.5% of the protein, including part of the critical ligand binding domain (PVS1_strong). RNA data showed two transcripts, one deleting amino acids 47-82 and one deleting aa63-82, both removing critical cysteine residues (Cys60 and Cys66) (PMID:26387786). SpliceAI (0.95) is consistent with a detrimental effect on splicing. Another variant in the same splice region, c.247+1, was classified as likely pathogenic by the PH VCEP (PS1_supporting). PP1, PS2, and PM6 were not assessed due to absence of co-segregation data. In summary, this variant meets the criteria to be classified as likely pathogenic for pulmonary arterial hypertension based on the ACMG/AMP criteria applied, as specified by the ClinGen Pulmonary Hypertension VCEP: PVS1_strong(RNA), PS1_supporting, PM2_supporting (VCEP specification version 2.0, 1/30/2026)