Debris Embolization to the Lung After a Bioprosthetic (Mitroflow®) Valve Fracture

This case report shows a valve in valve procedure in pulmonary position of a 19-year-old male with a repaired Tetralogy of Fallot. After initial correction, a Mitroflow 23 mm bioprosthetic valve was implanted in pulmonary position. Nine years later severe degeneration of the valve occurred. He underwent percutaneous Melody valve implantation after balloon valvuloplasty and controlled rupture of the Mitroflow prosthesis. A fragment from the fractured prosthesis migrated to the right pulmonary artery without clinical consequences. Postimplantation echocardiography revealed improved hemodynamics. Percutaneous valve implantation on a degenerated bioprosthetic valve is a rising technique with some concerns such as prosthetic-patient mismatch and potential debris embolization. This report emphasizes the successful use of balloon fracture to achieve larger diameters for the newly implanted valve and notes that debris embolization does not appear to have a clinical impact.