For rheumatic mitral stenosis with suitable valve morphology, percutaneous mitral balloon valvuloplasty remains the established first-line intervention. The harder problem is degenerative, heavily calcified mitral stenosis — increasingly common with aging populations and mitral annular calcification — where surgery is often high-risk or infeasible. Here, novel percutaneous approaches are emerging, including calcium-debulking techniques and off-label use of aortic balloon-expandable bioprostheses implanted in the mitral position (valve-in-mitral-annular-calcification). These have shown favorable early hemodynamics and procedural feasibility in patients who are poor surgical candidates, though long-term durability data are still being collected.
Further reading: new percutaneous approaches for heavily calcified mitral stenosis (Sanz-Ruiz et al., 2022).