Parallel Transcatheter Valve and Stent Placement with Subsequent Stent Occlusion to Address a Giant Dysfunctional...

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart defect whose surgical repair has improved long-term survival. However, many patients develop right ventricular outflow tract (RVOT) dysfunction and severe pulmonary insufficiency (PI), often leading to right ventricular dilatation and arrhythmias. Pulmonary valve replacement (PVR) is the standard treatment. Open surgery remains the preferred option in many cases, especially when the RVOT is large or has a complex anatomy. However, in patients with significant comorbidities that increase surgical risk, percutaneous options may be a viable alternative. In the case we present, an innovative approach was used, as the patient was not a candidate for surgery due to his high comorbidity (bladder neoplasm, obesity and severe obstructive respiratory pattern) and his giant RVOT posed a challenge for percutaneous valve options. A large Myval^® 32 mm prosthesis was implanted, occupying the rest of the RVOT with a vascular stent in parallel occluded by a vascular plug device. This approach, although uncommon, has proven to be a viable palliative option in selected cases, providing an improvement in right ventricular function and reducing symptoms.