Acute Leaflet Dysfunction in Transcatheter Pulmonary Valves

Abstract

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.