about 75 y old patient with dyspnea. we found a high-grade stenosis of the aortic valve (middle pressure gradient about 45-50 mmHg, EF< 20%). Notwithstanding the use of dobutamine and levosimendan (haemodynamics permanent controlled by catheter in pulmonary capillaries) hemodynamic stabilisation was out of reach, so we performed a valvuloplasty.