Percutaneous balloon aortic valvuloplasty (PAV) has been reported in children and in selected adults with aortic stenosis using retrograde arterial catheterization. Some patients, however, cannot undergo retrograde catheterization because of atherosclerotic disease, previous vascular surgery or the presence of vessel tortuosity. Because PAV requires the use of large balloon dilating catheters, extreme bleeding and local arterial damage are potential complications. The results of PAV using the anterograde transseptal approach were compared with those using the retrograde arterial approach. Diminution in aortic gradient and increase in aortic valve area were similar in the 2 groups. Vascular complications were more common using the retrograde approach (4 vs 0). Thus, PAV can be performed successfully using anterograde transseptal catheterization. This technique of PAV could be particularly useful in patients who cannot undergo retrograde arterial catheterization.