Usefulness of shock wave lithotripsy as pretreatment for balloon valvuloplasty in calcified mitral stenosis

Abstract

A closed commissurotomy of the mitral valve is likely to be successful only if the valve is pliable, neither severely fibrotic nor calcified. 1–3 In vitro studies and single observations in patients have shown, however, that heavily calcified mitral stenoses can be opened in certain cases by means of balloon catheters. 4–6 Nevertheless, the results of balloon valvuloplasty as well as of commissurotomy in these circumstances are less favorable and the rate of valvular incompetence is higher. 7 Because large calcified foci are responsible for this, it seemed appropriate to examine the possibility of achieving more favorable conditions for balloon valvuloplasty by breaking up calcifications with shock waves. To our knowledge, no such investigation has been made to date.