Key result
Left internal jugular access enables successful Harmony transcatheter pulmonary valve implantation after failed standard approaches.
Why the study?
Interrupted inferior vena cava with azygos continuation and innominate vein stenosis complicate large-bore venous access for transcatheter pulmonary valve replacement, requiring alternative access strategies.
Does the left internal jugular vein approach allow for successful transcatheter pulmonary valve replacement in patients with severe pulmonary regurgitation and complex venous anatomy (interrupted IVC and innominate-SVC stenosis)?
Case Report (n=1)
Does the left internal jugular vein approach allow for successful transcatheter pulmonary valve replacement in patients with severe pulmonary regurgitation and complex venous anatomy (interrupted IVC and innominate-SVC stenosis)?
The left internal jugular vein can serve as a viable alternative access route for transcatheter pulmonary valve replacement when interrupted IVC and right-sided venous stenosis preclude standard large-bore venous access.
Background The Harmony transcatheter pulmonary valve (TPV) system is designed to treat severe pulmonary regurgitation in patients with native or surgically repaired right ventricular outflow tracts. Case summary A 22-year-old woman with prior balloon valvuloplasty for congenital pulmonary valve stenosis presented with symptomatic severe pulmonary valve regurgitation. Femoral transcatheter valve delivery was unsuccessful due to an interrupted inferior vena cava (IVC) with azygos continuation to the superior vena cava. A subsequent right internal jugular attempt failed because of innominate-SVC stenosis related to prior venous instrumentation. Successful implantation of a 25-mm Harmony TPV was achieved via the left internal jugular vein. Discussion Interrupted IVC with azygos continuation can complicate large-bore venous access and necessitate alternative strategies.
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Raja et al. (2026) conducted a case report in Severe pulmonary valve regurgitation with interrupted IVC and innominate vein stenosis (n=1). Left internal jugular transcatheter pulmonary valve replacement using Harmony TPV was evaluated on Successful valve implantation. Successful implantation of a 25-mm Harmony transcatheter pulmonary valve was achieved via the left internal jugular vein after failed femoral and right internal jugular attempts.
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