Surgical retrieval and repositioning of malpositioned prosthetic pulmonic valve in a patient with situs inversus dextrocardia and tetralogy of Fallot: a case report.

INTRODUCTION

Percutaneous pulmonary valve implantation (PPVI) offers a minimally invasive alternative to surgical valve replacement in patients with right ventricular outflow tract dysfunction. However, valve malposition or migration can occur, necessitating surgical retrieval.

CASE PRESENTATION: We report a 16-year-old male with situs inversus dextroposition, mirror-image dextrocardia, and repaired Tetralogy of Fallot (TOF), who developed severe pulmonary regurgitation and underwent PPVI using a MyVal valve in another hospital. Post-procedural imaging revealed valve malposition at the right pulmonary artery bifurcation with paravalvular leakage. Surgical retrieval and reimplantation of the same prosthetic valve were successfully performed on a beating heart under cardiopulmonary bypass.

DISCUSSION: This case highlights the challenges of percutaneous interventions in complex congenital heart anatomies and the role of early surgical management in salvaging malpositioned valves. Beating-heart reimplantation minimized myocardial ischemia and facilitated rapid recovery.

CONCLUSION

Prompt surgical retrieval and reimplantation of malpositioned PPVs can preserve valve function, reduce morbidity, and optimize outcomes in complex congenital heart disease.