Leaflet entrapment causing acute severe aortic insufficiency during balloon aortic valvuloplasty

Cusp entrapment is a previously unreported mechanism of aortic insufficiency after balloon aortic valvuloplasty. In a patient who developed severe acute aortic insufficiency and expired after balloon aortic valvuloplasty, pathologic evaluation revealed a large, solitary, fractured, calcific nodule in the noncoronary cusp in which the malaligned, irregular fracture surfaces of the nodule had entrapped the leaflet in an open position. The ease with which the entrapped leaflet was reduced by manipulation on postmortem examination suggests that further manipulation of the cusp might restore valve competence in some cases when aortic insufficiency occurs after balloon valvuloplasty in calcific aortic stenosis.