Cracking a Bioprosthesis in Pulmonary Position With Subsequent Percutaneous Pulmonary Valve Implantation (PPVI) Is Safe-But Size Matters: A Word of Caution.

We report on an adult patient with severe bioprosthesis stenosis and patient-prosthesis mismatch who was treated by percutaneous pulmonary valve implantation (PPVI) preceded by covered stent implantation and valve cracking, using a high-pressure balloon, 5 mm larger than the internal bioprosthesis valve diameter. Although the hemodynamic result was satisfactory, the patient developed pericardial and right pleural hematoma, which was treated successfully by surgical emergency means. Caution is advised when the fracture of a dysfunctional surgical bioprosthesis is intended with high-pressure dilatations using significantly bigger balloons than the labeled valve size.