First-in-Human Valve-in-Valve Implantation of a Self-Expanding Pulmonary Valve Within a Dysfunctional Balloon-Expandable Pulmonary Valve.

BACKGROUND: Patients with repaired tetralogy of Fallot often require pulmonary valve interventions. Valve-in-valve transcatheter pulmonary valve replacement is an established strategy for degenerated pulmonary valves, but self-expanding valves within previously implanted balloon-expandable valves remain extremely limited. FIRST-IN-HUMAN/EARLY REPORTS SUMMARY: A 26-year-old man with repaired tetralogy of Fallot and prior Myval transcatheter heart valve (Meril Life Sciences Pvt. Ltd) implantation presented with exercise intolerance, severe pulmonary regurgitation, and right ventricular dilation. After computed tomography-based planning, redilation of the prosthetic valve, a Venus P-Valve was implanted within the dysfunctional balloon-expandable valve, resulting in a competent valve. DISCUSSION: This case suggests that, in selected regurgitant failures with adequate landing-zone length and successful scaffold preparation, a balloon-expandable valve may serve as a suitable platform for self-expanding valve-in-valve implantation. NOVELTY: This is, to our knowledge, the first Venus P-Valve implanted within a previously implanted balloon-expandable pulmonary valve. TAKE-HOME MESSAGE: Venus P-Valve implantation may be used as a transcatheter valve-in-valve solution in selected cases beyond native right ventricular outflow tract anatomies.