Acute Leaflet Dysfunction in Transcatheter Pulmonary Valves.

BACKGROUND: Acute leaflet dysfunction after transcatheter pulmonary valve (TPV) implantation is a rare but clinically important complication that remains poorly characterized. CASE SUMMARY: We report 2 cases of acute stuck leaflet causing significant pulmonary regurgitation immediately postimplantation, the first such cases confirmed with intracardiac echocardiography in the pulmonary position. Case 1 involved a 23-mm Sapien 3 Ultra Resilia valve in a 39-year-old woman with repaired tetralogy of Fallot, requiring emergent valve-in-valve implantation with a 22-mm Melody TPV. Case 2 involved a 25-mm Harmony TPV in a 54-year-old woman, who was managed conservatively and is pending repeat catheterization. Standard rescue maneuvers including balloon dilation and catheter manipulation proved ineffective in both cases. DISCUSSION: This report highlights the importance of maintaining high clinical suspicion for acute leaflet dysfunction, the utility of intracardiac echocardiography for early diagnosis, and the need for valve-in-valve preparedness during TPV procedures.