Key result
Residual shunt after TPVI causes mechanical hemolysis that resolves with blood pressure control.
Why the study?
Clinically significant hemolysis after transcatheter pulmonary valve implantation is extremely rare and the mechanisms are not well understood.
Case Report (n=1)
Residual shunt lesions adjacent to the right ventricular outflow tract may generate localized high-shear stress against the prosthetic frame, highlighting the risk of mechanical hemolysis and the need for careful multimodality imaging prior to TPVI.
Residual shunts may trigger hemolysis after TPVI in repaired tetralogy of Fallot; leaves open optimal pre-procedural imaging and management strategies.
BACKGROUND: Transcatheter pulmonary valve implantation (TPVI) is an established treatment for severe pulmonary regurgitation after repaired tetralogy of Fallot, whereas clinically significant hemolysis is rare. CASE SUMMARY: A 39-year-old man with repaired tetralogy of Fallot developed severe pulmonary regurgitation with progressive right ventricular enlargement. TPVI using a self-expandable Harmony valve was successfully performed. Postprocedural dark-red urine and laboratory findings confirmed hemolysis. Multimodality imaging revealed a coronary artery-right ventricular fistula and residual ventricular septal defect adjacent to the valve. High-velocity shunt flow impinging on the prosthesis was considered the mechanism. Hemolysis resolved with blood pressure control alone. DISCUSSION: Residual shunt lesions adjacent to the right ventricular outflow tract may cause mechanical hemolysis after TPVI by generating localized high-shear stress. This case highlights the importance of comprehensive multimodality imaging before TPVI. TAKE-HOME MESSAGE: Residual shunt flow adjacent to the right ventricular outflow tract may cause mechanical hemolysis after TPVI.
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Hayashi et al. (2026) conducted a case report in Repaired tetralogy of Fallot with severe pulmonary regurgitation (n=1). Transcatheter pulmonary valve implantation (Harmony valve) was evaluated on Development of mechanical hemolysis. Transcatheter pulmonary valve implantation in a patient with repaired tetralogy of Fallot caused mechanical hemolysis due to residual shunt flow, which resolved with blood pressure control.
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