Epicardial open chest ventricular tachycardia ablation in no entry left ventricle

A 57-year-old patient with a history of aortic and mitral mechanical valve replacement was admitted with recurrent implantable cardioverter device shocks and antitachycardia pacing therapies. On electrocardiogram, the clinical ventricular tachycardia (VT) was compatible with an antero-lateral peri-mitral basal exit. Because of the inability to access the left ventricle through a percutaneous approach, epicardial VT ablation was performed. The VT and a second VT, consistently induced and coming from the left ventricular apex, were successfully treated with epicardial cryoablation via median sternotomy under cardiopulmonary bypass. Double aortic and mitral mechanical valve prosthesis represent a major anatomical challenge for ventricular tachycardia (VT) ablation, for the lack of access to the left ventricle (LV) (no entry LV).