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ObjectivePreclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH).MethodsBetween July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66–92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8–23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO2); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially.ResultsAfter CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1–5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m2and room-air resting SatO2 decreased by 6.2±1.9% (pConclusionThe interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory.Trial registration numberNCT03554330.

Background The formation of left ventricular apical aneurysm (LVAA) is a distinctive subset in hypertrophic cardiomyopathy (HCM), however, it is still unknown about myocardial viability of LVAAs in these patients. Objectives The study was carried out to assess the myocardial viability of LVAAs in HCM patients. Methods Of 510 HCM patients, 21 (4.1%, 17 M/4 F) were identified as HCM with LVAAs. Coronary artery disease was ruled out by selective coronary angiography or coronary computed tomography angiography (CTA). Myocardial viability of LVAAs was assessed by single photon emission computed tomography (SPECT), positron emission tomography (PET) and delayed-enhancement magnetic resonance imaging. Results Viable LVAAs were identified in 8 HCM patients and nonviable LVAAs presented in the other 13 patients. Left ventricular obstruction presented in 15 patients, including 3 patients with mid-ventricular obstruction. In all LVAAs, the aneurysmal wall was thin ( Conclusions Viable LVAAs existed in a small proportion of HCM patients, and might develop into nonviable LVAAs. This finding warranted further investigations to reassess the mechanism, treatment considerations and prognosis of the disease.