Management of a doubly folded, partially inflated Melody valve after outer balloon rupture: a case report

This is a report of a rare complication during implantation of a Melody valve in an adult patient in whom the valve failed to expand due to balloon rupture. An 18-year-old patient was admitted with an increased right ventricular pressure and severe pulmonary regurgitation for scheduled cardiac catheterization. Angiography revealed a proximal stenosis of the left pulmonary artery (LPA). First, a prestenting was performed. Three months later he came back for planned percutaneous pulmonary valve implantation (PPVI). Because of the proximity of the right coronary artery (RCA) to the right ventricular outflow tract (RVOT) and thus a relatively short landing zone, the Melody valve had been doubly folded. During the inflation of the outer balloon, it ruptured. At this point, the Melody valve was still fixed to the inner balloon. A second catheter was placed through the Melody valve and successful valve implantation was possible. This procedure was difficult because to push the catheter through the partly inflated Melody valve, the inner balloon had to be slowly and simultaneously deflated. The final angiograms and pressure measurements showed a good functional result and absent pulmonary regurgitation. Open heart surgery could be avoided after incomplete Melody valve dilatation using the contralateral pulmonary artery as a safe rail.