Novel Bailout for Pulsta Valve Embolization: Microporous Endograft Fixation at the SVC-RA Junction in Repaired Tetralogy of Fallot With Severe Pulmonary Regurgitation.

This report describes a 47‑year‑old woman with a history of repaired tetralogy of Fallot presenting with a massively dilated native right ventricular outflow tract (RVOT) and enlarged pulmonary arteries. She underwent bilateral branch pulmonary artery valve implantation using self-expanding Pulsta valves. Early embolization of the left pulmonary artery valve necessitated a complex percutaneous rescue, including balloon anchoring, through-and-through wiring, and stepwise relocation. Following a subsequent embolization into the right ventricle resulting in tricuspid entrapment, emergent surgical retrieval was recommended but declined by the patient's family. Consequently, the migrated prosthesis was ultimately managed via definitive fixation at the superior vena cava-right atrium (SVC-RA) junction using an off-label, fenestrated thoracic covered stent. This approach successfully avoided emergent redo sternotomy, illustrating a novel and effective transcatheter bailout strategy for embolized pulmonary valves in challenging RVOT anatomies when surgical intervention is refused.