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

## TL;DR

A new technique using IVL helped treat a patient with severe mitral stenosis after prior surgery, where traditional options were not viable.

## Contribution

The first-in-human use of IVL to facilitate PMBC in a complex mitral valve anatomy after prior annuloplasty band repair.

## Key findings

- IVL-facilitated PMBC improved gradients and symptoms in a high-risk patient with prior surgical repair.
- IVL can modify calcified leaflets in complex postsurgical anatomy to enable commissurotomy.
- Larger studies are needed to confirm the safety and long-term outcomes of IVL-facilitated PMBC.

## Abstract

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

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.

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

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.