Novel Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm in Repaired Tetralogy of Fallot.

Background

Ruptured sinus of Valsalva aneurysm (RSVA) following tetralogy of Fallot (TOF) repair is exceedingly rare, with only isolated cases reported. CASE SUMMARY A 53-year-old man with TOF repaired in infancy presented with NYHA functional class IV heart failure. Cardiac computed tomography showed a ruptured right sinus of Valsalva (28.1 × 33.5 mm) draining into the main pulmonary artery. Cardiac catheterization confirmed a left-to-right shunt (pulmonary-to-systemic flow ratio, 2.6:1) with normal pulmonary vascular resistance. Given the prohibitive surgical risk, a 25-mm Harmony pulmonary valve was deployed, achieving complete RSVA occlusion, restoring pulmonary valve competence, and reducing right ventricular pressure. Functional status improved to NYHA functional class II.

Discussion

We describe a novel transcatheter approach in repaired TOF, simultaneously addressing RSVA and severe pulmonary regurgitation in a single intervention. TAKE-HOME MESSAGES RSVA should be suspected in adults with repaired TOF presenting with unexplained heart failure. Transcatheter closure with a Harmony valve may be feasible in carefully selected high-risk surgical candidates with suitable anatomy and concomitant pulmonary valve disease.