Hybrid approach for aortic balloon valvotomy

Hybrid Approach For Balloon Aortic Valvotomy.
15 y old female with congenital bicuspid severe Aortic stenosis and poor LV function.
LVEF : 30%.
Retrograde wire .035, .032 straight regular and glide was unsuccessful to cross Aortic valve.
Decided to come antigrade through transeptal puncture.
RA - LA - MV - LV - AV.
Antigrade wire snared in ascending aorta and externalised.
Retrograde cath cross in LV over externalised wire.
Then remaining procedure was done retrogradily.
Successful procedure with great reduction in gradient.