Mitral valve rupture during percutaneous dilation of aortic valve stenosis

A 62-year-old patient underwent catheter balloon valvuloplasty for aortic valve stenosis. During the procedure, iatrogenic severe mitral regurgitation was induced, requiring emergency surgery. At operation, extensive laceration of the septal mitral leaflet was found; chordae tendinae were intact. Retrospective examination of the cineangiogram revealed the presence of balloon indentation at the chordal level during inflation, which disappeared at full inflation. Mitral valve rupture was probably related to balloon entrapment in chordae tendinae, severe chordal stretching at inflation, and subsequent valve laceration. This severe complication or aortic valvuloplasty in adults has not been reported previously and probably could be avoided by careful observation of guidewire and balloon position before inflation.