Double balloon aortic valvuloplasty in TAVI era: insight from intracardiac echocardiography and multidetector computed tomography findings.

Retrograde double-balloon aortic valvuloplasty (DBAV) is a more effective method for decreasing the transvalvular gradient as compared to the conventional single-balloon technique for patients with severe aortic stenosis (AS). However, the potential risk of pressure-induced annulus injury remains a concern. In the present report, we describe a case of severe AS complicated with severe peripheral artery disease that was successfully treated with DBAV using bilateral brachial access. Multidetector computed tomography (MDCT) was used to measure the precise aortic annulus, and the procedure was guided by intracardiac echocardiography (ICE). Our findings suggest that DBAV is an effective method for achieving hemodynamic improvement, and our ICE findings combined with the MDCT measurements support the safety and efficacy of this historical technique.