Novel Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm in Repaired Tetralogy of Fallot.

BACKGROUND: Ruptured sinus of Valsalva aneurysm (RSVA) following tetralogy of Fallot (TOF) repair is exceedingly rare, with only isolated cases reported. CASE SUMMARY: A 53-year-old man with TOF repaired in infancy presented with NYHA functional class IV heart failure. Cardiac computed tomography showed a ruptured right sinus of Valsalva (28.1 × 33.5 mm) draining into the main pulmonary artery. Cardiac catheterization confirmed a left-to-right shunt (pulmonary-to-systemic flow ratio, 2.6:1) with normal pulmonary vascular resistance. Given the prohibitive surgical risk, a 25-mm Harmony pulmonary valve was deployed, achieving complete RSVA occlusion, restoring pulmonary valve competence, and reducing right ventricular pressure. Functional status improved to NYHA functional class II. DISCUSSION: We describe a novel transcatheter approach in repaired TOF, simultaneously addressing RSVA and severe pulmonary regurgitation in a single intervention. TAKE-HOME MESSAGES: RSVA should be suspected in adults with repaired TOF presenting with unexplained heart failure. Transcatheter closure with a Harmony valve may be feasible in carefully selected high-risk surgical candidates with suitable anatomy and concomitant pulmonary valve disease.