Sequential Melody Valve Insertion After Repair of Tetralogy of Fallot Atrioventricular Septal Defect.

Repair of tetralogy of Fallot with atrioventricular septal defect may be associated with hemodynamic challenges in the postoperative period particularly as left atrial hypertension secondary to left atrioventricular valve dysfunction may exacerbate pulmonary regurgitation and augment low cardiac output. We present a case describing hybrid strategies to treat severe left atrioventricular and pulmonary valve regurgitation with modified balloon expandable stent valves to counter low cardiac output secondary to valve dysfunction. Such strategies offer an alternative to standard valve choices and should be considered as an extension of the current surgical valve inventory.