1. The patient• Female patient, 76 years old,• Aortic stenosis, accepted for TAVI,• Technical details:

Porcelain aortaAortic annulus: 21 x 23 mm

2. The procedure• Echo-guided femoral access,• Crossing aortic valve (Amplatz left-2, Kimal straight),• Balloon valvuloplasty (23 x 60 mm Z-Med balloon):

3. The problem• No crossing of the 26 mm CRS (whatever we did),

4. The solution• 6 Fr Pigtail in commissure into LV (“Buddy Pigtal”):

5. The question

• The etiology of no crossing?

- Is it patient related?- Is it anatomy related?- Is it device related?- Is it operator related?

• Did anyone else experience this problem?

• How did you solve the problem?