Hypoattenuating Leaflet Thickening After Transcatheter Pulmonary Valve Implantation: An Urgent Call to Action

The Venus P-Valve is a novel self-expanding prosthesis designed for transcatheter pulmonary valve implantation (TPVI) in patients with severe pulmonary regurgitation and dilated right ventricular outflow tracts. This case series assessed the incidence of subclinical leaflet thrombosis, defined as hypoattenuated leaflet thickening (HALT), and reduced leaflet motion 6 months after TPVI in 7 patients treated between January and April 2023. HALT was detected via computed tomography angiography in 71% of patients, primarily affecting the right cusp. Despite the high incidence of HALT, no significant valve dysfunctions or adverse clinical events were documented. Patients with HALT were treated with oral anticoagulation, resulting in a reduction of HALT at follow-up. These findings underscore the uncertainty regarding the short-term clinical relevance of HALT and reduced leaflet motion, emphasizing the need for individualized antithrombotic strategies. Larger studies are required to evaluate the long-term impact and optimal therapeutic approach for patients undergoing TPVI with the Venus P-Valve.