Rupture of a calcified right ventricle to pulmonary artery homograft by balloon dilation– emergency rescue by venus P-Valve
Dublin Core
Title
Rupture of a calcified right ventricle to pulmonary artery homograft by balloon dilation– emergency rescue by venus P-Valve
Subject
Congenital heart defect, Tetralogy of Fallot (TOF), Right ventricular outflow tract (RVOT) obstruction,
Calcified right ventricular outflow conduit rupture, Venous P-valve
Calcified right ventricular outflow conduit rupture, Venous P-valve
Description
Background Percutaneous pulmonary valve implantation (PPVI) is a recognized alternative treatment to surgery for
patients with dysfunctional right ventricular outflow tracts. Patient selection is essential to avoid serious complications
from attempted treatment, such as rupture or dissection, especially of the calcified outflow tracts. We describe a case
with an unexpected rupture of a calcified homograft valve and main pulmonary artery, which was treated successfully
by emergency implantation of a self-expanding Venus P-Valve (Venus MedTech, Hangzhou, China) without the need
for pre-stenting with a covered stent.
Case details A 13-year-old boy had two previous operations of tetralogy of Fallot, one a total repair and the other
a homograft valved conduit for pulmonary regurgitation. He presented with dyspnea and severe right ventricular
outflow tract obstruction (RVOTO) and had a calcified outflow tract and main pulmonary artery. In the catheter
laboratory, a non-compliant balloon dilation resulted in a contained rupture of the conduit. The patient remained
hemodynamically stable, and the rupture was treated with a self-expandable Venus P-Valve without the need for a
covered stent combined with a balloon-expandable valve or a further surgical procedure.
Discussion Preprocedural evaluation with an inflating balloon is necessary to examine tissue compliance and
determine suitability for PPVI. However, this condition is accompanied by a risk of conduit rupture. Risk factors of
this complication are calcification and homograft use. These ruptures are mostly controlled with a prophylactic or
therapeutic covered stent, with a low rate of requiring surgery. However, there are severe ruptures which lead to
hemothorax and death. In the available literature, there was no similar reported case of conduit rupture, which a self-
expandable Pulmonary valve stent has managed. It seems that fibrosis and collagen tissue around the heart, formed
after open surgeries, can contribute to the control of bleeding in these cases.
Conclusion (clinical Learning Point) The suitability of patients for the PPVI procedure should be examined more
carefully, specifically patients with homograft and calcification in their conduit. Furthermore, conduit rupture might
be manageable with self-expandable artificial pulmonary valves, specifically in previously operated patients, and the
applicability of this hypothesis is worth examining in future research.
patients with dysfunctional right ventricular outflow tracts. Patient selection is essential to avoid serious complications
from attempted treatment, such as rupture or dissection, especially of the calcified outflow tracts. We describe a case
with an unexpected rupture of a calcified homograft valve and main pulmonary artery, which was treated successfully
by emergency implantation of a self-expanding Venus P-Valve (Venus MedTech, Hangzhou, China) without the need
for pre-stenting with a covered stent.
Case details A 13-year-old boy had two previous operations of tetralogy of Fallot, one a total repair and the other
a homograft valved conduit for pulmonary regurgitation. He presented with dyspnea and severe right ventricular
outflow tract obstruction (RVOTO) and had a calcified outflow tract and main pulmonary artery. In the catheter
laboratory, a non-compliant balloon dilation resulted in a contained rupture of the conduit. The patient remained
hemodynamically stable, and the rupture was treated with a self-expandable Venus P-Valve without the need for a
covered stent combined with a balloon-expandable valve or a further surgical procedure.
Discussion Preprocedural evaluation with an inflating balloon is necessary to examine tissue compliance and
determine suitability for PPVI. However, this condition is accompanied by a risk of conduit rupture. Risk factors of
this complication are calcification and homograft use. These ruptures are mostly controlled with a prophylactic or
therapeutic covered stent, with a low rate of requiring surgery. However, there are severe ruptures which lead to
hemothorax and death. In the available literature, there was no similar reported case of conduit rupture, which a self-
expandable Pulmonary valve stent has managed. It seems that fibrosis and collagen tissue around the heart, formed
after open surgeries, can contribute to the control of bleeding in these cases.
Conclusion (clinical Learning Point) The suitability of patients for the PPVI procedure should be examined more
carefully, specifically patients with homograft and calcification in their conduit. Furthermore, conduit rupture might
be manageable with self-expandable artificial pulmonary valves, specifically in previously operated patients, and the
applicability of this hypothesis is worth examining in future research.
Creator
Hojjat Mortezaeian1
, Ata Firouzi1
, Pouya Ebrahimi3
, Mohsen Anafje2,6*, Peyman Bashghareh1
, Phuoc Doung4
and
Shakeel Qureshi5
, Ata Firouzi1
, Pouya Ebrahimi3
, Mohsen Anafje2,6*, Peyman Bashghareh1
, Phuoc Doung4
and
Shakeel Qureshi5
Source
https://doi.org/10.1186/s12245-024-00702-5
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
englsih
Type
text
Files
Collection
Citation
Hojjat Mortezaeian1
, Ata Firouzi1
, Pouya Ebrahimi3
, Mohsen Anafje2,6*, Peyman Bashghareh1
, Phuoc Doung4
and
Shakeel Qureshi5, “Rupture of a calcified right ventricle to pulmonary artery homograft by balloon dilation– emergency rescue by venus P-Valve,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12431.