First Transcatheter Pulmonary Valve Replacement in Tanzania: Feasibility of Advanced Cardiac Interventions in Resource-Limited Settings.

BACKGROUND

Transcatheter pulmonary valve implantation (TPVI) has emerged as a viable alternative to surgical pulmonary valve replacement for patients with congenital heart disease and right ventricular outflow tract dysfunction. However, its adoption in low-resource settings has been limited.

CASE SUMMARY: We report the first successful TPVI procedures in Tanzania. Case 1 involved a 16-year-old male with Noonan syndrome and prior homograft conduit for pulmonary atresia and ventricular septal defect. Case 2 was a 16-year-old female with repaired Tetralogy of Fallot who had undergone prior surgical valve replacement with a Trifecta valve. Both patients presented with severe right ventricular outflow tract dysfunction and underwent successful TPVI with a 20-mm Melody valve (Medtronic) without complications. Postprocedural imaging confirmed hemodynamic improvement and symptom relief.

DISCUSSION: These first-in-country cases demonstrate the feasibility of TPVI in resource-limited settings. Broader implementation will require cost-reduction strategies, industry collaboration, and provider training to overcome financial and technical barriers.

TAKE-HOME MESSAGE: TPVI can be safely implemented in low- and middle-income countries through structured planning and partnerships.