Abstract
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.