Implantation of a Self-Expanding Transcatheter Pulmonary Valve as a Salvage Procedure After Embolization of a Prestent.

BACKGROUND

Transcatheter pulmonary valve implantation is well established for patients with repaired tetralogy of Fallot and pulmonary valve dysfunction. We report a case of a procedural complication salvaged using a self-expanding valve deployed innovatively.

CASE SUMMARY: A 23-year-old male with repaired tetralogy of Fallot and severe pulmonary regurgitation underwent transcatheter pulmonary valve implantation. An Edwards Sapien 3 valve with Cheatham Platinum prestenting was planned. The procedure was complicated by Cheatham Platinum stent embolization into the cry (main pulmonary artery [MPA]), with unsuccessful repositioning. A self-expanding Venus-P valve was deployed through the embolized stent, trapping it against the MPA wall, restoring valve function, and avoiding emergency surgery.

DISCUSSION: This case highlights challenges of balloon-expandable valves in large MPA anatomy and the versatility of self-expanding valves in managing complications.

TAKE-HOME MESSAGES: Self-expanding valves can provide effective bailout options for complications such as embolized stents. Expertise in different valve platforms allows for decision-making flexibility.