Key result
Deployment of the Harmony transcatheter pulmonary valve without a DrySeal sheath through the femoral vein to the azygous vein pathway is feasible in a patient with interrupted inferior vena cava and lack of internal jugular access.
Why the study?
When a patient's anatomy precludes the standard femoral venous approach for Harmony valve delivery, such as with vascular occlusions or an interrupted IVC, alternative delivery options are essential.
Case Report (n=1)
No
Deployment of the Harmony transcatheter pulmonary valve via the azygous vein is feasible in patients with an interrupted inferior vena cava and lack of internal jugular access.
May enable Harmony TPVR via azygous access in interrupted IVC; leaves open confirmation in larger series.
BACKGROUND: In 2021, the Food and Drug Administration approved the Harmony Transcatheter Pulmonary Valve System (Medtronic) for the treatment of pulmonary valve regurgitation in pediatric and adult populations with a native or surgically repaired right ventricular outflow tract, thus extending transcatheter pulmonary valve replacement to accommodate larger native right ventricular outflow tract anatomies. CASE SUMMARY: We present the case of a 15-year-old female with a history of heterotaxy, transannular patch repair of double outlet right ventricle, bilateral superior vena cava, interrupted inferior vena cava (IVC), who presented with progressive right ventricular dilation and reduced endurance by cardiopulmonary exercise testing. DISCUSSION: The most common way of delivering the Harmony valve is through the femoral venous approach. When the patient's anatomy precludes femoral venous access, such as vascular occlusions or an interrupted IVC, an alternative option is essential. TAKE-HOME MESSAGE: Deployment of the Harmony valve without a DrySeal sheath through the femoral vein to the azygous vein pathway is feasible in patients with interrupted IVC and lack of internal jugular access.
No takes yet. Share an insight, caveat, or question.
Prieto et al. (2025) conducted a case report in Severe pulmonary regurgitation and severe right ventricular dilation (n=1). Harmony Transcatheter Pulmonary Valve System deployment via azygous vein was evaluated on Successful valve deployment and reduction of pulmonary regurgitation. Deployment of the Harmony transcatheter pulmonary valve without a DrySeal sheath through the femoral vein to the azygous vein pathway is feasible in a patient with interrupted inferior vena cava and lack of internal jugular access.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: