Abstract
Left ventricular (LV) perforation accompanied by acute cardiac tamponade is a rare but one of the most feared complication during transcatheter aortic valve implantation. Few cases with the need of emergent surgical repair are described in literature. Handling of this uncommon but possible life-threatening event requires well-considered action by the implanting team and is associated with substantially increased intrahospital mortality. We present a unique case of LV perforation management with percutaneous pericardiocentesis only. As a possible underlying physiological mechanism, we identified the movement of the ventricular muscle band which possibly sealed the perforation side due to transverse and circumferential muscle contractions.