Intravascular lithotripsy-assisted intervention in patients with congenital heart disease.

OBJECTIVES

The use of intravascular lithotripsy (IVL) in patients with calcified coronary and peripheral arterial disease is now commonplace; however, its use in procedures specific to congenital heart disease is rare, with a very limited published case-based experience to date. The authors report the outcomes of 4 patients with congenital heart disease who underwent IVL-assisted transcatheter procedures in the effort to inform future operators as to the potential benefits and risks of this technology in this patient population.

METHODS AND

RESULTS

Four patients underwent IVL-assisted transcatheter procedures including branch pulmonary artery stenting, aortic coarctation stenting, and transcatheter pulmonary valve replacement. All 4 patients underwent successful IVL-assisted implantation of large stents in highly calcified native or surgically implanted biological conduits without significant complications.

CONCLUSIONS

The use of IVL-assisted interventions in patients with severe native or surgical calcified vascular conduits is feasible and may be a useful adjunct in conduit stent implantation and dilation. Vascular injury during angioplasty of calcified vessels and conduits remains a concern despite the use of lithotripsy, and covered stent implantation should be considered prior to aggressive dilation in order to reduce the risk of catastrophic rupture.