Using Shockwave Lithotripsy to Treat Severe Calcified Mitral Stenosis in a Pregnant Woman

Rheumatic mitral stenosis (MS) with significant calcification presents challenges for both surgical and transcatheter interventions. Percutaneous balloon mitral valvuloplasty (PBMV) is often limited in these cases due to valve rigidity, increasing the risk of mitral regurgitation (MR). Transcatheter mitral valve lithotripsy (TMVL) is an emerging technique that uses sonic waves to disrupt calcification, enhancing valve pliability and PBMV outcomes. A 39-year-old woman, 18 weeks pregnant, with a history of rheumatic heart disease and prior surgical mitral commissurotomy, presented with palpitations, fatigue, and exertional breathlessness. She had severe MS (mitral valve area 0.8 cm²) and severe tricuspid regurgitation, with atrial fibrillation and rapid ventricular response. Due to a high Wilkins score, PBMV was attempted with a 28 mm Inoue balloon inflated to 28 mm, but was suboptimal due to significant valve rigidity. Adjunctive TMVL improved valve pliability, successfully reducing the mitral gradient and increasing valve area without worsening MR. The patient continued her pregnancy without complications. This case highlights TMVL as a promising adjunct to PBMV in severe calcified MS, particularly in high-risk patients such as pregnant women. Further studies are needed to validate its efficacy and long-term outcomes.