ivl辅助二尖瓣成形术

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105216

Filippo Novarese MD , Matteo Vercellino MD , Italo Porto MD, PhD

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引用次数: 0

摘要

目的介绍一种新的血管内碎石辅助二尖瓣球囊成形术治疗严重二尖瓣狭窄和重度小叶钙化的方法。该方法采用双导向护套和0.018英寸环形导丝，以确保球囊的最佳定位和操作稳定性。关键步骤1)经中隔后穿刺球囊造口术；2)经双股静脉通路插入2个Agilis可操纵鞘；0.018英寸环形导丝推进左心室心尖3)在钙化小叶上定位2个12mm IVL球囊；4)脉冲碎石后经皮二尖瓣球囊成形术，球囊为22 × 40 mm。潜在的缺陷复杂的双鞘操作、瓣膜下损伤的风险以及对先进成像技术和操作人员专业知识的依赖可能会限制经验不足的中心的重复性。可操纵鞘和环形导丝的结合增强了IVL球囊的控制和疗效，为二尖瓣严重钙化的高危患者提供了可行的策略。

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IVL-Assisted Mitral Valvuloplasty

Objective

To describe a novel intravascular lithotripsy (IVL)–assisted technique for percutaneous balloon mitral valvuloplasty in patients with severe mitral stenosis and heavy leaflet calcification. The approach employs dual steerable sheaths and looped 0.018-inch guidewires to ensure optimal balloon positioning and procedural stability.

Key Steps

1) Midposterior transseptal puncture with balloon septostomy; 2) insertion of 2 Agilis steerable sheaths via dual femoral venous access; advancement of looped 0.018-inch guidewires to left ventricular apex; 3) positioning of 2 12-mm IVL balloons across the calcified leaflets; 4) lithotripsy pulse delivery followed by percutaneous balloon mitral valvuloplasty using a 22 × 40 mm balloon.

Potential Pitfalls

Complex dual sheath manipulation, risk of subvalvular injury, and dependence on advanced imaging and operator expertise may limit reproducibility in less experienced centers.

Take-Home Message

The combination of steerable sheaths and looped guidewires enhances IVL balloon control and efficacy, offering a viable strategy for high-risk patients with severely calcified mitral valves.

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