dissociation. Resuscitative efforts were unsuccessful. Retrospective review of the cineangiography revealed that the balloon appeared to be acutely angled and indented as it traversed the left ventricular inflow tract to the outflow tract (Figure 1). At autopsy, the aortic valve was heavily calcified, severely stenotic and congenitally bicuspid (Figure 2A). An acute laceration was present at the anterolateral commissure between the mitral valve leaflets. Several chordae to the anterior leaflet were torn (Figure 2B). The posteromedial papillary muscle was ruptured (Figure 2, B and C). Microscopically, at the rupture sites there was a thin layer of platelets and fibrin deposition without evidence of necrosis of the adjacent myocytes (Figure 20).

Generally, most PBAV-associated complications have been described for retrograde valvuloplasty. Major complications occur in