Reoperative Pulmonary Valve Replacement via Left Mini-Thoracotomy in a Young Woman With Absent Pulmonary Valve Syndrome: A Case Report

Absent pulmonary valve syndrome is a rare congenital cardiac anomaly characterized by severe pulmonary valve insufficiency and progressive dilation of the right ventricular outflow tract and pulmonary arteries. Although primary surgical repair is typically performed during childhood, long-term outcomes are frequently limited by structural degeneration of bioprosthetic valves, often leading to the need for reintervention in early adulthood. We present the case of a 22-year-old woman with a history of pulmonary valve agenesis who underwent surgical correction during childhood, including implantation of an Edwards N21 bioprosthetic pulmonary valve and pulmonary artery plication. During follow-up, she developed progressive exertional dyspnea associated with a decline in functional capacity and was in New York Heart Association functional class III at the time of reoperation. Imaging studies demonstrated structural deterioration of the prosthetic valve, with evidence of right ventricular outflow tract involvement and hemodynamic compromise, supporting the indication for surgical reintervention. Pulmonary valve re-replacement was successfully performed through a left mini-thoracotomy approach, allowing adequate exposure of the right ventricular outflow tract and main pulmonary artery while avoiding the risks associated with repeat sternotomy. The degenerated prosthesis was explanted and replaced with a new 25 mm Edwards bioprosthetic pulmonary valve, achieving satisfactory intraoperative hemodynamics and valve function. The postoperative course was uneventful, and the patient was discharged with significant clinical improvement and recovery of functional status. This case highlights that a left mini-thoracotomy approach represents a feasible and safe alternative for pulmonary valve re-replacement in selected patients with prior sternotomy. In addition to providing effective surgical exposure, this strategy may reduce operative trauma and facilitate postoperative recovery in complex reoperative congenital cardiac cases.