Abstract
We herein describe a 33-year-old woman with a mechanical aortic and mitral valve who developed repetitive monomorphic ventricular tachycardia with unstable hemodynamics. Catheter ablation by direct puncture at the left ventricular apex through a minithoracotomy successfully terminated the ventricular tachycardia, which had originated from the apical-septal endocardium in the left ventricle, despite the hindrance to routine access. No procedure-related complications or recurrence of the clinical ventricular tachycardia developed during a 66-month follow-up, demonstrating that endocardial ablation through direct cardiac cavity puncture can be considered in select cases.