Introduction
Balloon aortic valvuloplasty (BAV) was introduced as an alternative to aortic valve replacement in 1986; it has played a limited role in the treatment of patients with severe aortic stenosis (AS) owing to complication risks, lack of durability, and its minor impact on long-term survival.1, 2 However, in the era of transcatheter aortic valve replacement (TAVR), BAV is frequently utilized as a bridge procedure to TAVR for selected high-risk patients who cannot be immediate candidates for TAVR; thus, acute effectiveness and safety are required for BAV.3 Recently, the Inoue balloon for use in retrograde BAV (Toray, Chuo-ku, Japan) was newly invented. The hour-glass shaped balloon has multiple advantages, including stable fixation and multistage inflation characteristics, and therefore it does not impose any rapid ventricular pacing requirements to fix the balloon position during inflation, compared with cylindrical conventional balloons. We describe the BAV procedure which was safely performed using the newly invented Inoue balloon for retrograde approach in a high-risk patient.