Bilateral Modified Self-Expanding Valve Implantation in Branch Pulmonary Arteries

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Repaired tetralogy of Fallot with severe pulmonary regurgitation and right heart failure (n=1). Intervention: Modified Harmony valves (distal polyester fabric removed). Primary outcome: RV remodeling and symptom improvement.

Q: What does this research mean for the field?

Bilateral branch pulmonary artery implantation of modified Harmony valves with distal fabric removed is feasible and promotes right ventricular remodeling without branch obstruction in patients with severely dilated main pulmonary arteries. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Beka Bakhtadze; Lomaia Tg; Nicholas Szugye; Ryan Klatte; Joanna Ghobrial

doi:10.1016/j.jaccas.2026.108975

July 1, 2026JACC Case ReportsOpen Access

Bilateral Modified Self-Expanding Valve Implantation in Branch Pulmonary Arteries

View Full Paper

Ask AI

Bookmark

Share

Key result

Bilateral modified Harmony valve implantation shows feasibility for improving RV remodeling and symptoms.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Severe main pulmonary artery dilation can preclude transcatheter pulmonary valve implantation in repaired tetralogy of Fallot due to right ventricular outflow tract complexity.

Does bilateral implantation of modified self-expanding valves improve symptoms and right ventricular remodeling in a patient with repaired tetralogy of Fallot and severe pulmonary regurgitation unsuitable for standard intervention?

Key Points

To assess the feasibility of bilateral modified Harmony valve implantation in patients with repaired tetralogy of Fallot and severe pulmonary artery dilation.
A 67-year-old man with repaired tetralogy of Fallot and severe pulmonary regurgitation underwent bilateral Harmony valve implantation.
Valves were modified by removing distal polyester fabric to prevent branch pulmonary artery obstruction.
Three-month follow-up included assessments of right ventricular remodeling and symptom improvement.
The patient demonstrated improvement in right ventricular function and symptoms at three months post-implantation.
Bilateral Harmony valve implantation was achieved without segmental branch pulmonary artery obstruction.
Modification allowed for effective transcatheter pulmonary valve intervention in severely dilated pulmonary arteries.

Study Design

Type

Case Report (n=1)

Structured PICO

Does bilateral implantation of modified self-expanding valves improve symptoms and right ventricular remodeling in a patient with repaired tetralogy of Fallot and severe pulmonary regurgitation unsuitable for standard intervention?

P

Population

A 67-year-old man with repaired tetralogy of Fallot, severe pulmonary regurgitation, and right heart failure followed for 3 months.

I

Intervention

Bilateral transcatheter pulmonary valve implantation using modified self-expanding valves (distal polyester fabric removed from rows 1 and 2 to prevent segmental branch pulmonary artery obstruction) implanted sequentially in bilateral pulmonary arteries.

O

Outcome

Right ventricular remodeling and symptom improvement at 3-month follow-up

Implication

Modification of self-expanding transcatheter pulmonary valves by removing distal fabric allows for feasible bilateral pulmonary artery implantation in patients with severe main pulmonary artery dilation.

Abstract

BACKGROUND: Transcatheter pulmonary valve implantation (TPVI) in repaired tetralogy of Fallot is challenging due to right ventricular (RV) outflow tract complexity. Severe main pulmonary artery (PA) dilation can preclude TPVI, a platform limitation. CASE SUMMARY: A 67-year-old man with repaired tetralogy of Fallot, severe pulmonary regurgitation, and RV dysfunction presented with right heart failure. Prior institutions deemed him unsuitable for surgical or transcatheter intervention. After multidisciplinary discussion, Harmony valves (Medtronic) were modified by removing distal polyester fabric (rows 1 and 2) to prevent segmental branch PA obstruction, and implanted sequentially in bilateral PAs. RV remodeling and symptom improvement were noted at 3-month follow-up. DISCUSSION: This first reported modified Harmony valve case demonstrates feasibility of bilateral PA implantation without branch obstruction, expanding TPVI options in severely dilated PAs. TAKE-HOME MESSAGE: Modifying the Harmony valve by distal fabric removal preserves segmental PA flow and maintains radial force and valve function in branch PA TPVI.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Bakhtadze et al. (2026) conducted a case report in Repaired tetralogy of Fallot with severe pulmonary regurgitation and right heart failure (n=1). Modified Harmony valves (distal polyester fabric removed) was evaluated on RV remodeling and symptom improvement. Bilateral implantation of modified Harmony valves with distal fabric removed was feasible and resulted in RV remodeling and symptom improvement at 3 months.

synapsesocial.com/papers/6a47556d5c29257aa257a738 https://doi.org/10.1016/j.jaccas.2026.108975

View Full Paper

Ask AI

Bookmark

Share

Bilateral Modified Self-Expanding Valve Implantation in Branch Pulmonary Arteries

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Bilateral Modified Self-Expanding Valve Implantation in Branch Pulmonary Arteries

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Keep reading

More related papers

More from JACC Case Reports

Keep reading

More related papers

More from JACC Case Reports