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

Department

Cardiology

Document Type

Article

Publication Title

JACC Case Reports

Abstract

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.

First Page

106562

DOI

10.1016/j.jaccas.2025.106562

Volume

31

Issue

7

Publication Date

2-18-2026

PubMed ID

41709807

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