Aortic valve perforation during aortic valvuloplasty: Identification and strategies for prevention

Balloon aortic valvuloplasty has seen a revival in interest because of its role in predilation and preparation of the annulus before trans catheter aortic valve implantation. Aortic valve cusp perforation is a serious complication that needs early recognition and prompt corrective measures to prevent a poor procedural outcome or conversion to emergent surgery. A number of useful angiographic and technical findings can alert the operator about the possibility of this complication. Failure to recognize cusp perforation can lead to serious procedural complications like severe aortic regurgitation, suboptimal prosthesis deployment, and function that can necessitate emergent open cardiac surgery.