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.