Left ventricular perforation during cardiac catheterization in a case of severe calcific aortic stenosis. Should we cross the valve?

With the availability of better hardware and refinements in catheterization techniques, perforation of cardiac structures at cardiac catheterization is a rare event. We report, a 54-year old male who developed LV rupture during a pre-aortic valve replacement catheterization with ensuing tamponade, after several attempts were made to cross a heavily calcified aortic valve. The issues regarding whether the calcific aortic valve should be crossed when reliable echo and color Doppler information is available are discussed along with recent recommendations.