First-in-Human Use of Intravascular Lithotripsy to Facilitate Mitral Balloon Commissurotomy After Prior Annuloplasty Band Repair.

BACKGROUND

Patients with severe mitral stenosis (MS) after surgical repair often face limited therapeutic options owing to high surgical risk and complex valve anatomy.

CASE SUMMARY: A 79-year-old woman with prior surgical mitral valve repair presented with severe MS. Given her high surgical risk and extensive valvular calcification, she was not a candidate for redo surgical mitral valve, percutaneous mitral balloon commissurotomy (PMBC), or transcatheter mitral valve-in-ring. Intravascular lithotripsy (IVL)-facilitated PMBC was performed, with postprocedural improvement in gradients and symptoms.

DISCUSSION: IVL was used to modify calcific leaflets, enabling successful commissurotomy in complex postsurgical anatomy. Comparative hemodynamic data are needed to clarify IVL's contribution.

TAKE-HOME MESSAGES: IVL can be used off-label for severe MS with prior incomplete annuloplasty band where surgery, transcatheter mitral valve-in-ring, and PMBC are not viable options. IVL-facilitated PMBC still remains investigational; larger studies and longer term follow-ups are required to define safety, durability, and patient outcomes.