First-in-man experience with cryoplasty during graded balloon atrial septostomy to reduce spontaneous closure in a patient with severe pulmonary arterial hypertension

A 46-year-old African-American female with a history of diabetes, morbid obesity and World Health Organization group IV pulmonary hypertension (PH) secondary to chronic thromboembolic disease was referred to us for atrial septostomy. She was not a candidate for surgical thromboendarterectomy because of the distal location of the thromboembolic disease, nor was she a candidate for lung transplantation due to morbid obesity. She remained symptomatic despite maximal medical therapy including continuous intravenous treprostinil, sildenafil, and bosentan. Due to persistent symptoms of dyspnoea New York Heart Association (NYHA) Class IV with recurrent syncopal episodes on exertion and further deterioration of right ventricular ...