LAUSR

An 88-year-old female with recurrent heart failure due to severe aortic stenosis underwent antegrade balloon aortic valvuloplasty (ant-BAV) using Inoue balloon catheter (Toray, Tokyo, Japan). Preprocedural coronary angiogram revealed no significant stenosis. The stiff wire was across from left atrium, via mitral valve and left ventricle to the descending aorta and captured by the snare catheter (Fig. 1a). The Inoue balloon was advanced over the intraventricular wire loop to a position across aortic valve. During this manipulation, holding the stiff wire made the snare fixing point and the wire to be pulled down near to aortic valve, indicating strong wire tension (Fig. 1b). Incidentally, there was a new-onset left bundle branch block (LBBB) (Fig. 1c). Her hemodynamic state was stable and then, dilatation was performed using stepwise technique (Fig. 1d). Even though the LBBB was continued during the procedure, it was improved after 6 h without advancement to atrioventricular block (Fig. 1e, f). The successful reduction in transaortic valve gradient and increase in AV area resulted in improvement of her clinical condition. Cardiac conduction disturbances while retrograde BAV (retro-BAV) and transcatheter aortic valve implantation are previously reported and associated with balloon oversizing [1]. In this case, the mechanical stress by stiff-wire intraventricular loop during advancement of the Inoue balloon caused the new-onset LBBB regardless of balloon inflation. Although the maximum characteristic of ant-BAV the stiffwire loop with snare fixing offers several advantages over retro-BAV, this procedure gives stronger wire-loop stress for intra-ventricular conduction systems. In positioning of the