An 81-years-old lady was referred to our center for trans-catheter aortic valve-in-valve (ViV) replacement due to stenotic structural degeneration of a 6-years-old sutureless size M Perceval bioprosthesis (LivaNova) ( Fig. 1 .A). Based on cardiac computed tomography, a 23-mm balloon-expandable Sapien 3 Ultra (Edwards Lifesciences) trans-catheter heart valve (THV) was chosen. The THV was inserted through the right femoral artery but, at the end of its deployment, the balloon ruptured with evidence of suboptimal frame expansion ( Video 1 ). An attempt to retrieve the Commander delivery system into the e-Sheath failed due to the “umbrella shape” of the proximal part of the ruptured balloon and resulted in its complete detachment from the system ( Video 2 ). Positioning of a 20-Fr right femoral sheath did not translate into retrieval success ( Fig. 1 .B). A 16-Fr sheath was introduced from the left femoral artery, allowing the insertion of a 30-mm Goose Neck catheter (Medtronic). The tip of the extra-support guidewire was snared in the descending aorta and pulled back into the 16-Fr left sheath ( Video 3 ). However, the ruptured balloon did not smoothly transit into the 16-Fr sheath. For this reason, we inserted via the right femoral artery a 7.0 × 40 mm Admiral Xtreme balloon catheter (Medtronic) inside a 7-Fr Multipurpose guiding catheter (Medtronic) ( Fig. 1 .C). In that way, advancing the Admiral Xtreme balloon, we were able to externalize the rupture balloon directly from the left femoral artery ( Fig. 1 .D-E and Video 4 ). After the curly tip was cut, the stiff wire was pulled back from the right femoral sheath. The left femoral access was successfully closed tying two pre-positioned Prostyle (Abbott). Lastly, after a new super-stiff wire was positioned in the left ventricle, the THV was post-dilated with a 22 × 45 mm non-compliant TRUE dilatation balloon (Bard Vascular), achieving a satisfying result ( Video 5 ). No vascular complications were observed after percutaneous right femoral closure ( Fig. 1 .F). Balloon rupture of a THV is an uncommon and unexpected event during trans-catheter aortic valve replacement. This complication is poorly described in literature and appears to be difficultly managed by one arterial access [1] . We described a case in which the ipsilateral retrieval of the ruptured balloon had been not possible due the its acquired “umbrella shape” preventing its entrance even in the 20-Fr sheath. Contralateral snaring and externalization resulted in a procedural success. Whenever compatible with femoral dimensions, choice of a contralateral large-bore sheath should be recommended.