Percutaneous balloon release of a stuck mechanical aortic valve in cardiogenic shock

Background Mechanical prosthetic aortic valve obstruction is a life-threatening condition that may present with cardiogenic shock. Surgical intervention is often definitive but may carry prohibitive risk in critically ill or inoperable patients. Case presentation We report the case of a 78-year-old woman with a history of mechanical aortic valve replacement who presented with progressive dyspnea and severe prosthetic aortic valve stenosis due to leaflet restriction. Despite thrombolytic therapy for possible valve thrombosis, she remained in refractory cardiogenic shock and was deemed a nonsurgical candidate. The multidisciplinary Heart Team elected to proceed with percutaneous balloon aortic valvuloplasty (BAV) to mechanically release the restricted leaflet under cerebral embolic protection. This last resort intervention led to immediate hemodynamic and echocardiographic improvement without acute complications. Conclusion This case highlights percutaneous balloon intervention as a potential rescue therapy in selected patients with obstructed mechanical aortic valves when thrombolysis fails and immediate surgery is prohibitive.