Key result
Transbaffle valve-in-valve implantation delivers immediate hemodynamic improvement in failing Fontan bioprosthesis.
Why the study?
Only a few cases of transbaffle valve-in-valve implantation in the systemic atrioventricular position have been reported in patients with Fontan circulation and prohibitive surgical risk.
Case Report (n=1)
No
This case demonstrates the feasibility of transbaffle transcatheter valve-in-valve implantation for systemic atrioventricular bioprosthetic stenosis in a high-risk adult patient with complex Fontan anatomy.
Answers are grounded in this paper and cite their sources.
May offer a less invasive option in high-risk Fontan patients; extends prior case reports but leaves durability and applicability open.
BACKGROUND: We report the case of a 29-year-old woman with an atrioventricular canal defect with left ventricular hypoplasia and mitral atresia in the setting of situs inversus and dextrocardia, palliated with Fontan circulation. CASE SUMMARY: At 21 years of age, she underwent systemic atrioventricular valve replacement with a 33-mm Hancock II bioprosthesis (Medtronic). Eight years later, she developed progressive bioprosthetic stenosis: mean transvalvular gradient of 11 mm Hg with restricted leaflet motion. Given prohibitive surgical risk, transcatheter valve-in-valve (ViV) implantation using a 29-mm Sapien 3 (Edwards Lifesciences) prosthesis was performed via transbaffle access. The procedure resulted in immediate hemodynamic improvement with reduction of the mean gradient. DISCUSSION: Only a few cases of transbaffle ViV implantation in the systemic atrioventricular position in patients with a Fontan circulation have been reported. TAKE-HOME MESSAGE: This case illustrates the feasibility of transbaffle ViV implantation in complex Fontan anatomy and highlights transcatheter therapy as a valuable alternative in high-risk adult congenital heart disease.
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Quennelle et al. (2026) conducted a case report in Systemic atrioventricular bioprosthetic stenosis in Fontan circulation (n=1). Transbaffle transcatheter valve-in-valve implantation using a 29-mm Sapien 3 prosthesis was evaluated on Hemodynamic improvement and reduction of mean transvalvular gradient. Transbaffle valve-in-valve implantation with a 29-mm Sapien 3 prosthesis achieved immediate hemodynamic improvement in a 29-year-old Fontan patient with an 11 mm Hg mean bioprosthetic gradient.
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