Misadventure During Balloon Mitral Valvuloplasty, a Complication Despite All Precautions

Accidental aortic puncture is a much dreaded and potentially serious complication of transseptal catheterization and was recognized in the initial description of the technique by J. Ross Jr and colleagues in 1958.1 However, inadvertent puncture of the pulmonary artery, although theoretically possible and despite the vast experience with transseptal balloon mitral valvuloplasty, has never been described. We present a unique case in which balloon mitral valvuloplasty in a pregnant patient was complicated by puncture of the right main pulmonary artery. We also discuss possible mechanisms and approach to management.