Left ventricular apical puncture: A procedure surviving well into the new millennium

We report two patients with a history of prior mitral valve and aortic valv e replacement with St. Jude prosthetic valves, who were referred for repeat valve replacement after noninvasive assessment was suggestive of prostheti c valve malfunction. Both patients were managed medically after evaluation with direct left ventricular apical puncture revealed normal hemodynamics i n the first and mild aortic stenosis in the second patient. These two cases illustrate that, despite the advancements in the noninvasive evaluation of prosthetic heart valves, left ventricular direct puncture continues to hav e an important value in the evaluation of patients referred for repeat valv e replacement, and it can prevent unnecessary surgeries associated with a h igh risk of morbidity and mortality. (C) 2000 Wiley-Liss, Inc.