Complete atrioventricular block improved by balloon aortic valvuloplasty for severe aortic stenosis: Usefulness of sheathless technique in the retrograde approach

An 86-year-old man was admitted to our hospital for treatment of congestive heart failure with severe aortic stenosis and advanced atrioventricular (AV) block. Despite pharmacological therapy, he developed complete AV block and resultant acute pulmonary edema requiring temporary pacing and tracheal intubation. We urgently performed retrograde balloon aortic valvuloplasty (BAV) with a sheathless technique. The AV block disappeared soon after the procedure; this was probably attributable to the correction of relative myocardial ischemia, obtained by BAV. Thus, he successfully recovered from a critical condition. <Learning objective: It is widely accepted that balloon aortic valvuloplasty (BAV) dramatically reduces the systolic pressure gradient across the stenotic aortic valve, but the other important hemodynamic point is that it increases the coronary perfusion pressure by raising the diastolic blood pressure, both of which contribute to improving the imbalance between myocardial oxygen demand and supply. And the sheathless technique in retrograde BAV, although not yet popular, is less invasive and may be promising in urgent clinical situations.>.