JACC. Case reports · 2025
IVL-Assisted Mitral Valvuloplasty: The Dual Deflectable Sheath Technique.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Novarese Filippo, Vercellino Matteo, Porto Italo
Аннотация
OBJECTIVE: To describe a novel intravascular lithotripsy (IVL)-assisted technique for percutaneous balloon mitral valvuloplasty in patients with severe mitral stenosis and heavy leaflet calcification. The approach employs dual steerable sheaths and looped 0.018-inch guidewires to ensure optimal balloon positioning and procedural stability.
KEY STEPS: 1) Midposterior transseptal puncture with balloon septostomy; 2) insertion of 2 Agilis steerable sheaths via dual femoral venous access; advancement of looped 0.018-inch guidewires to left ventricular apex; 3) positioning of 2 12-mm IVL balloons across the calcified leaflets; 4) lithotripsy pulse delivery followed by percutaneous balloon mitral valvuloplasty using a 22 × 40 mm balloon.
POTENTIAL PITFALLS: Complex dual sheath manipulation, risk of subvalvular injury, and dependence on advanced imaging and operator expertise may limit reproducibility in less experienced centers.
TAKE-HOME MESSAGE: The combination of steerable sheaths and looped guidewires enhances IVL balloon control and efficacy, offering a viable strategy for high-risk patients with severely calcified mitral valves.
KEY STEPS: 1) Midposterior transseptal puncture with balloon septostomy; 2) insertion of 2 Agilis steerable sheaths via dual femoral venous access; advancement of looped 0.018-inch guidewires to left ventricular apex; 3) positioning of 2 12-mm IVL balloons across the calcified leaflets; 4) lithotripsy pulse delivery followed by percutaneous balloon mitral valvuloplasty using a 22 × 40 mm balloon.
POTENTIAL PITFALLS: Complex dual sheath manipulation, risk of subvalvular injury, and dependence on advanced imaging and operator expertise may limit reproducibility in less experienced centers.
TAKE-HOME MESSAGE: The combination of steerable sheaths and looped guidewires enhances IVL balloon control and efficacy, offering a viable strategy for high-risk patients with severely calcified mitral valves.