Bilateral Branch Pulmonary Artery Melody Valve Implantation for Treatment of Complex Right Ventricular Outflow Tract Dysfunction in a High-Risk Patient

Percutaneous pulmonary valve replacement is one of the most important advancements in the field of interventional cardiology in the past decade.1,2 However, currently available technologies are not applicable to patients with oversized right ventricular outflow tracts (RVOTs), especially when there is concomitant proximal branch pulmonary artery (PA) stenosis. This combination commonly is encountered in clinical practice. Our group has a longstanding interest in these complex patients, and we have recently published preclinical studies describing the feasibility and short-term effects of implanting 2 Melody valves—1 into each proximal branch PA—in an ovine model of postoperative pulmonary insufficiency and dilated RVOT.3 This report describes bilateral branch PA Melody valve implantation to treat complex RVOT dysfunction in a high-risk patient.At presentation, the patient was a 27-year-old woman with a complex medical history. Her cardiac condition was double-outlet RV with pulmonary stenosis and interrupted inferior vena cava with azygos continuation to a left-sided superior vena cava. She was status post-Waterston shunt as an infant, with subsequent closure of the ventricular septal defect and patch augmentation of the RVOT. Three months before catheterization, the patient presented to her cardiologist with symptoms of progressive activity intolerance over the past year. She was oxygen dependent and on long-term continuous positive airway pressure therapy. Comorbidities included VATER and Klippel-Feil syndromes, renal agenesis, Mullerian agenesis, gout, and obesity. The patient had undergone multiple spinal fusion and Harrington rod procedures as well as repair of tracheoesophageal …