Anterograde crossing of a bicuspid aortic valve through transseptal access to facilitate transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) for bicuspid aortic valve stenosis can pose several technical challenges including difficult valve crossing. We report the case of a 77-year-old woman undergoing transfemoral TAVI for symptomatic severe bicuspid aortic stenosis. It proved impossible to cross the bicuspid aortic valve retrogradely despite the use of multiple catheters and wires and attempts by two interventional cardiologists. We describe a novel approach to antegrade crossing, through a transseptal access, to permit retrograde implant of prosthesis.