gerbode type defect after trans-septal puncture for ablation of left-sided accessory pathway

Background: trans-septal puncture (tsp) is a safe and effective method to approach left atrium and ventricle. nowadays, cardiac electrophysiologists perform this procedure routinely to treat left-sided arrhythmias. case report: a 45-year-old man was referred to our center due to wolff-parkinson-white (wpw) syndrome. after trans-septal puncture, contrast injection into the sheath showed that it was in the left ventricle (lv) rather than left atrium. trans-esophageal echocardiography confirmed left ventricle outflow tract to right atrial (ra) jet. follow-up echocardiography showed that the tract was present up to 18 months, but considering that the patient was asymptomatic, endovascular or surgical closure was not done. conclusion: our case with an 18-month follow-up period, highlights the conservative approach in asymptomatic patients with this complication.