Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction

Background Valved conduits from the right ventricle to the pulmonary artery are frequently used in paediatric cardiac surgery. However, stenosis and i nsufficiency of the conduit usually occur in the follow-up and lead to reop erations. Conduit stenting can delay surgical replacement, but it aggravate s pulmonary insufficiency. We developed an innovative system for percutaneo us stent implantation combined with valve replacement. Methods A 12-year-old boy with stenosis and insufficiency of a prosthetic c onduit from the right ventricle to the pulmonary artery underwent percutane ous implantation of a bovine jugular valve in the conduit. Findings Angiography, haemodynamic assessment, and echocardiography after t he procedure showed no insufficiency of the implanted valve, and partial re lief of the conduit stenosis. There were no complications after 1 month of follow-up, and the patient is presently in good physical condition. Interpretation We have shown that percutaneous valve replacement in the pul monary position is possible. With further technical improvements, this new technique might also be used for valve replacement in other cardiac and non -cardiac positions.