Calcified Pulmonary Artery Conduit With Distal Embolism

The Rastelli procedure is a standard surgical repair for congenital heart disease (CHD). Improved long-term survival has revealed rare complications previously unrecognized. We report a unique case of a patient with a history of Rastelli repair who presented with left-sided heart failure. Diagnostic workup revealed a calcified pulmonary artery conduit and multiple sites of pulmonary embolism (PE) presumed to originate from fragments of the conduit. The PE was initially masked by nonspecific heart failure symptoms. Multimodality cardiovascular imaging was essential for diagnosis. This is the first reported case of calcified PE from a degenerated pulmonary artery conduit in a Rastelli patient. While right ventricular outflow tract complications are known, calcium-related embolic phenomena are underrecognized. This case highlights a rare but significant complication that may increase as CHD survival improves. Surveillance imaging in CHD patients is vital to detect late structural complications. Individualized treatment is essential for rare PE etiologies.