A Practical Surgical Technique for Removing a Transcatheter Pulmonary Valve

We report a 22-year-old man with pulmonary atresia and an intact ventricular septum who presented with infective endocarditis after transcatheter pulmonary valve implantation with a Medtronic Harmony valve. Methicillin-susceptible Staphylococcus aureus was identified. Imaging revealed vegetations, severe valve dysfunction, multiple pulmonary emboli, and expansion with embedding of the distal stent flare at the pulmonary artery bifurcation. Despite antibiotic therapy, infection persisted, necessitating urgent surgery. A tourniquet-assisted purse-string technique with a protective outer tube was used to constrain the stent flare and enable safe explantation. Right ventricular outflow tract reconstruction was completed using a bioprosthetic valve and graft. The patient's postoperative course was uneventful.