Step-by-Step Intravascular Lithotripsy-Assisted Balloon Valvuloplasty for Calcific Mitral Valve Stenosis.

objectiveSevere calcific mitral stenosis remains challenging to treat. In high-risk or inoperable patients without transcatheter valve replacement options, percutaneous balloon mitral valvuloplasty (PBMV) may be considered, but it carries risks of valvular injury, worsening regurgitation, and embolic events. PBMV facilitated by intravascular lithotripsy (IVL) has emerged as a novel method to improve valve compliance and enable safer balloon dilation. We detail the step-by-step technique of IVL-facilitated PBMV. KEY STEPS: Bilateral Sentinel devices were deployed. Transseptal puncture was performed. Peripheral Shockwave balloons were positioned across the mitral annulus to perform lithotripsy. PBMV was performed with a noncompliant balloon. POTENTIAL PITFALLS: Risks include embolic stroke from calcium debris and postprocedural regurgitation. Mitigation strategies include cerebral embolic protection, careful computed tomographic and echocardiographic assessment, and optimized balloon sizing and technique. TAKE-HOME MESSAGES: IVL-facilitated PBMV may offer feasible, effective, and safe therapy in patients with severe calcific mitral stenosis who lack suitable surgical or other transcatheter options. Long-term durability of IVL-facilitated PBMV still needs validation.