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Feasibility and safety of parallel shockwave balloon percutaneous mitral commissurotomy for degenerative mitral stenosis
Session:
Prémio Melhor Comunicação Oral
Speaker:
Daniel Inácio Cazeiro
Congress:
CPC 2026
Topic:
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Theme:
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Subtheme:
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Session Type:
Sessão de Prémios
FP Number:
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Authors:
Fabio Viveiros; Daniel Inácio Cazeiro; Pedro Carrilho Ferreira; Claúdia Jorge; Miguel Nobre Menezes; Pedro Cardoso; Fausto Pinto; João Silva Marques
Abstract
<p><strong>Introduction</strong></p> <p>Treatment of degenerative mitral valve stenosis (DMVS) is challenging, with most transcatheter and surgical techniques carrying high morbidity/mortality. Conventional percutaneous mitral commissurotomy (PMC) is often contraindicated, as most cases present with heavily calcified leaflets and/or absence of commissural fusion. In this setting, the use of shockwave lithotripsy (LT) has emerged as a novel therapeutic approach in these patients (pts), with favorable hemodynamic (HD), clinical and safety outcomes.</p> <p> </p> <p><strong>Purpose</strong></p> <p>To describe a novel technique of PMC with 2 parallel shockwave LT balloons through a single transseptal puncture and characterize its HD and safety results.</p> <p> </p> <p><strong>Methods</strong></p> <p>Retrospective, single center analysis of pts with DMVS, who were deemed unsuitable for surgery and were scheduled to undergo PMC with shockwave LT, after multidisciplinary HeartTeam evaluation.</p> <p> </p> <p><strong>Results</strong> </p> <p>Three pts were submitted to PMC with shockwave LT (median age 73 years, 67% female). Two pts were deemed unsuitable for surgery due to porcelain aorta, whereas 1 pt was rejected due to advanced age and comorbidities. All pts presented significant leaflet and mitral annular calcification (MAC) and were not eligible for percutaneous valve-in-MAC.</p> <p> </p> <p>The procedure was performed as described:</p> <p>1. Preprocedural transthoracic echocardiography for evaluation of noninvasive transmitralgradients (TMG), estimated MV area and mitral regurgitation (MR);</p> <p>2. Establishment of 2 arterial and 2 venous accesses. Deployment of a cerebral embolic protection device (CEPD) and a pigtail catheter through the arterial accesses. Progression of an intracardiac echocardiography probe and an over-the-wire sheath to the right atrium;</p> <p>3. Transseptal puncture. Over-the wire progression of 2 steerable sheaths and pigtail catheters to the left atrium. Invasive assessment of left ventricular pressure and TMG;</p> <p>4. Progression of a guidewire through the pigtail catheter and subsequent delivery of two 12mm Shockwave® E6 balloons;</p> <p>5. Sequential and simultaneous balloon inflations with LT delivery (30 pulses per cycle; total 540–600 pulses) without ventricular pacing. Assessment of final TMG.</p> <p>6. Retrieval of CEPD and access closure.</p> <p> </p> <p>Median noninvasive and invasive preprocedural TMG were 16mmHg and 11mmHg, respectively. After PMC, significant HD improvements were observed, with final noninvasive and invasive median TMG of 7mmHg. No worsening of baseline MR was observed. There were no immediate major complications. </p> <p> </p> <p><strong>Conclusion</strong></p> <p>This case series illustrates the feasibility and safety of MV balloon valvuloplasty using Shockwave LT in inoperable pts with DMVS. The approach achieved significant HDimprovement without increasing MR or causing procedural complications. These findings support LT-assisted MV valvuloplasty as a potential option for pts with unfavorable anatomy for conventional percutaneous or surgical therapy.</p>
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