Authors

• Antun Zvonimir Kovač — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-6276-4450
• Denis Došen — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-3490-5505
• Irena Ivanac Vranešić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-6910-9720
• Miroslav Muršić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-1578-4525
• Maja Hrabak Paar — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-0390-8466
• Kristina Marić Bešić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4004-7271

Keywords

congenitally corrected transposition of the great arteries, percutaneous pulmonary valve implantation, Melody pulmonary valve

DOI

Full Text

**Introduction**: In patients with congenitally corrected transposition of the great arteries (CCTGA), atrioventricular and ventriculoarterial discordance maintains physiologic circulation. However, early surgical intervention is often required due to associated anomalies such as septal defects, pulmonary valve dysfunction, or subpulmonary outflow tract obstruction (1). Over time, implanted conduits and bioprosthetic valves undergo degeneration, necessitating reintervention. Percutaneous pulmonary valve implantation (PPVI) has emerged as a less invasive alternative to surgical procedures (2). Here, we present a case of PPVI in a degenerated outflow tract conduit. **Case report**: 37-year-old woman with a history of CCTGA presented with progressive exertional dyspnea. She had her first surgery at the age of 9 – patch repair of septal defects and homograft implantation from the left ventricle to the pulmonary artery with the hypoplastic native pulmonary artery left in place. The second operation was at the age of 21 years – replacement of the degenerated homograft with a Conterga conduit. Echocardiography and cardiac magnetic resonance imaging revealed dysfunction of the Contegra conduit with mild stenosis and severe valve regurgitation. Additionally, severe mixed disease of the native pulmonary valve was noted, along with subpulmonary ventricular dilation and elevated filling pressures, while ventricular function remained preserved. Computed tomography angiography confirmed the feasibility of a PPVI. The patient underwent elective PPVI with a Melody 22 bioprosthetic pulmonary valve within the Contegra conduit (**Figure 1**). No intervention was performed on the native pulmonary valve. The procedure was successful, with no residual regurgitation and a normal forward gradient. Postprocedural echocardiography demonstrated significant improvement in subpulmonary ventricular function, and the patient experienced no complications. FIGURE 1. CT image of a percutaneously implanted Melody valve in a Contegra conduit. **Conclusion**: This case highlights the effectiveness of PPVI as a safe and minimally invasive alternative to surgical reinterventions in patients with CCTGA and prior conduit placement. As bioprosthetic valve degeneration remains an ongoing challenge, transcatheter therapies offer a promising approach for long-term management in this complex patient population.

Literature

1. Kumar TKS. Congenitally corrected transposition of the great arteries. J Thorac Dis. 2020 March;12(3):1213–8. https://doi.org/10.21037/jtd.2019.10.15
2. Cabalka AK, Asnes JD, Balzer DT, Cheatham JP, Gillespie MJ, Jones TK, et al. Transcatheter pulmonary valve replacement using the melody valve for treatment of dysfunctional surgical bioprostheses: A multicenter study. J Thorac Cardiovasc Surg. 2018 April;155(4):1712–1724.e1. https://doi.org/10.1016/j.jtcvs.2017.10.143