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Updated: Jan 16, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
IVL-Assisted Mitral Valvuloplasty: The Dual Deflectable Sheath Technique
Filippo Novarese1, Matteo Vercellino2, Italo Porto3
1Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy.
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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