ACUTE CORONARY SYNDROME DURING LITHOTRIPSY-ASSISTED BALLOON MITRAL VALVULOPLASTY

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Lithotripsy-assissted mitral balloon valvuloplasty is an emerging therapy for mitral stenosis. Complications of the procedure is not well studied. Case A 49 year-old lady with severe mitral stenosis and NYHA class III heart failure was referred for balloon valvuloplasty. Echocardiogram showed severe annular and bileaflet calcification with mean gradient of 15mmHg and valve area of 0.7cm^2. Coronary arteriogram showed 80% lesion in proximal LAD (A) We performed balloon mitral annuloplasty and lithotripsy with a 2 12mm L6 lithotripsy balloons (B) followed by valvoplasty with 28mm balloon (C) guided by intracardiac ultrasound. (D) We used cerebral embolic protection device. (E) Therapeutic heparinization was maintained. Immediately post valvuloplasty, patient had chest pain and ECG showed peaked precordial T waves. Coronary arteriogram showed occlusion of proximal LAD at the pre-existing lesion. (F) intravascular ultrasound showed plaque rupture with thrombus. (G). Decision-making We performed PCI with a 4.0 x 28mm stent, postdilated with 4.5/5.0 non-compliant balloons and restored TIMI 3 flow (H). No calcium debris was found from the embolic protection device. Echocardiogram showed reduction of mean gradient from 15mmHg to 6mmHg. Conclusion Embolisation is a known complication of PBMV but plaque rupture and thrombosis has not been reported before. A possible mechanism is disruption of calcified plaque from lithotripsy. [Formula presented]

Volume

83

Issue

13

First Page

4479

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