Transcatheter pulmonary valve implantation for re-intervention in recurrent right ventricular outflow tract obstruction.

Transcatheter pulmonary valve implantation (TPVI) has emerged as a less invasive alternative to surgical conduit replacement in patients with recurrent right ventricular outflow tract (RVOT) obstruction, particularly after repair of tetralogy of Fallot (TOF). We report a case of successful TPVI using a balloon-expandable MyVal transcatheter heart valve in a 58-year-old male with a complex cardiac history, including multiple prior surgeries and interventions for TOF and RVOT re-stenosis. The patient presented with severe symptoms, and multimodality imaging revealed severe right ventricle to pulmonary artery conduit stenosis, right-sided chamber dilation, and moderate biventricular dysfunction. Following thorough pre-procedural planning, TPVI was performed with conduit pre-dilation, deployment of a Cheatham platinum-covered stent to prevent conduit rupture, and implantation of a 23-mm MyVal valve. Post-procedural imaging confirmed optimal valve positioning, elimination of transconduit gradient, and resolution of pulmonary regurgitation. The patient was discharged on dual antiplatelet therapy with significant symptomatic improvement. This case highlights TPVI as a safe and effective re-intervention strategy in anatomically suitable high-risk patients with RVOT conduit dysfunction. While short-term outcomes are favourable, further data are warranted to assess long-term valve durability, particularly with newer valve technologies such as MyVal valve in the pulmonary position. Learning objectives: This case report demonstrates that transcatheter pulmonary valve implantation using a balloon-expandable MyVal valve with covered-stent reinforcement provides a safe, effective, and minimally invasive re-intervention for recurrent right ventricular outflow tract conduit obstruction in complex post-tetralogy of Fallot patients. It underscores the value of meticulous preprocedural imaging, coronary compression testing, and tailored device selection to ensure optimal valve deployment, gradient elimination, and symptomatic improvement, offering a compelling alternative to high-risk redo surgical conduit replacement.