Effect of Intravascular Lithotripsy on Mitral Annular Calcification: A Cadaveric Study

Mitral annular calcification (MAC) is a chronic condition where calcium deposits accumulate in the fibrous annulus of the mitral valve.Recent reports have suggested the potential feasibility of intravascular lithotripsy (IVL)-assisted percutaneous mitral valve interventions in patients with MAC. 1,2In this study, we conducted a study to evaluate the effect of IVL on MAC.A cadaveric heart with MAC was identified using photon-counting detector (PCD) computed tomography (CT; NAEOTOM Alpha Peak; Siemens Healthineers) (Figure 1A).The extracted heart was immersed in a water bath, and two 12.0-mm IVL L6 balloons (Shockwave Medical) and 1 scaffolding 12.0-mm compliant balloon, selected based on CT measurements (intercommissural distance, 28.8 mm; and anterior-posterior distance, 15.0 mm), was used to ensure optimal valve contact (Figure 1B).The IVL balloons (asterisks) were adjacent to the MAC and the scaffolding balloon (dagger) abutting the calcium-free annulus.The balloons were inflated to 4 atm to minimize balloon-induced fractures, with 50:50 contrast/saline per the manufacturer's recommendation.The hypothesis was that IVL would not cause fractures in dense MAC, and so, the maximal possible dose (600 pulses in total) was delivered.Post-IVL, the heart