When Transseptal Puncture Goes Astray: Conservative Management of Aortic Root Puncture During Balloon Mitral Valvotomy

Key Clinical MessageInadvertent aortic root puncture during transseptal access is a rare but potentially catastrophic complication.Clinical outcomes and management are strongly site-dependent.Early recognition using pressure waveform analysis, avoidance of sheath advancement, and guideline-informed decision-making are essential when conservative management is considered in hemodynamically stable patients.